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SKETCHES 



EPIDEMIC DISEASES 



STATE OF VERMONT ; 



FROM ITS FIRST SETTLEMENT TO THE TEAR 1815. WITH A CONSIDERATION 
OF THEIR CAUSES, PHENOMENA, AND TREATMENT. 



TO WHICH IB ADDED 



REMARKS ON PULMONARY CONSUMPTION. 



BY JOSEPH A. GALLUP, U. D. 



« Trace their slight bands, their secret haunts betray."— Zoonomi; 



BOSTON : 

PRINTED BY T. B. WAIT & SONS. 

Sold by Bradford fir Read, Boston, and other Booksellers in the United States, 

1815. 






^3 -\ 



DISTRICT OF VERMONT, TO WIT: 

BK it remembered, That on the sixteenth day of May, in the thirty-ninth year 

[L.S.] of the Independence of the United States of America, Joseph A. Gallup, of the said 

district, hath deposited in this office the title of a book, the right whereof he claims 

as author, in the words following, to wit : 

" Sketchts of Epidemie Diseases in the State of Vermont, from its first settlement to 

the year 1815 ; with a consideration of their causes, phenomena, and treatment. Tor 

which is added, remarks on Pulmonary Consumption. By Joseph A. Gallup, M. D. 

'Trace their slight bands, their secret haunts betray.' Zoonomia." 

In conformity to the act of the Congress of the United States, entitled "An act for the 
encouragement of learning, by securing the copies of Maps, Charts, and Books, to the 
authors and proprietors of such copies, during the times therein mentioned." 

JESSE GOVE, 
Clerk of the District of Vermont, 
A true copy of record, examined and sealed, by 
J. GOVE, Clerk, 



With salutations of respect, the following Sketches 
are inscribed to the Members composing the different 
Medical Societies in the State of Vermont, and with 
sincere wishes for their personal prosperity, and the 
common improvement of medical science. 
By their most obedient 

And very humble servant, 

THE AUTHOR* 



ERRATA.* 

Page 76, 11th line from top. The quotation from Dr. Lit- 
tlefield should include two lines more below, or to the next 
period. 

P. 102, 7th line from bottom, by our atmosphere, read in 
our atmosphere. 

P. 150, last line of note, tetatnus, read tetanus. 

P. 152, last line of the text, flaccid countenance, read placid 
countenance. 

P. 165, 15th line from top, venal glands, read renal glands. 

P. 221, 7th line from bottom, even seen, read ever seen. 

P. 250, 12th line from bottom, It is our lot, read, If it is 
our lot. 

P. 255, 6th line from top, dispersed, read dispensed, 

P. 293, 1st line, takes place read take place. 

P. 326, 6th line from bottom, my particular regimen, read 
any particular regimen. 

P. 328, 5th line from top, canrorum, read cancrorum. 

P. 374, 12th line from top, jalap, rea.djulap. 

* All errours of the transcriber, except the word even for ever, 
which is an errour of the press. 



CONTENTS. 



Preliminary Observations - - page 9 

CHAPTER I. 

Topographical sketches of the State of Vermont - 21 

CHAPTER II. 

History of epidemic diseases in the State of Vermont 33 

CHAPTER III. 

ON THE CAUSES OF FEVER. 

Introductory - - 84 

Sect. 1. Definition of hurtful principles - 86 

Miscellaneous observations - 88 

2. Elementary or epidemic diseases not contagious 95 

3. Remote influences affecting the system, which 

increase the liability to disease - 101 

4. Local or conjunct causes - 119 

Application - - 127 

5. Predisposition, or a greater liability to disease as 

an effect of remote influences - 135 

6. Exciting causes . - -141 
Prophylactic rules . 145 



CONTENTS. 



CHAPTER IV. 

ON FEVER IN GENERAL, 

Sect. 1. Definition of fever - - 147 

2. Phenomena of fever, in connection with its 

proximate cause - - 149 

3. Affections of the sympathetic nerves - 156 

4. Localities of disease - - 159 

5. Varied diseased action - - 161 

6. Depraved action of the stomach, liver, and kid- 

neys - 162 

7. Depraved action of the skin - - 165 

8. Thirst - 166 

9. Heat - - - 166 

10. Spasms, convulsions, delirium, coma - 167 

11. Solids and fluids - - - 169 

12. Oppressed action - - - 170 

13. Unequal action - - 171 

14. Remissions, paroxysms, periods of fever - 171 



CHAPTER V. 

ON THE TREATMENT OF FEVER, OR FEBRILE ACTION IN 
GENERAL. 

Sect. 1. On the first or depressed state of fever .. 175 

2. On the second stage of fever, or high excitement 1 94 

3. On the third stage of fever with exhausted ex- 

citement, or indirect debility - - 205 

Chronic states of fever - - 214 

Remarks on mercury and opium - 216 



CONTENTS. Vli 

CHAPTER VI. 

ON 6P0TTED FEVER. 

Sect. I. History of the disease and symptoms ? 223 

2. Prognosis ... 235 

3. Appearances after death, and dissection - 236 

4. Pathological reflections - - 243 

5. On the treatment - - 248 

6. Sequel of spotted fever - - 275 

CHAPTER VII. 

ON EPIDEMIC PERIPNEUMONY. 

Sect. 1. Preliminary observations - - 281 

2. Dissections, &c. - - 285 

3. Dissertation on the cause, phenomena, and 

treatment - - 288 

CHAPTER VIII. 

ON DYSENTERY. 

Sect. 1. Preliminary observations - - 312 

2. Dissection, treatment, &c. - - 317 

3. Miscellaneous observations, and treatment con- 

tinued - - 323 



Vili C0NTENT9. 

CHAPTER IX. 

ANGINA EPIDEMICA. 

Sect. 1. Preliminary observations - - 332 

2. Symptoms - - - 338 

3. Treatment - 341 

4. Sequel of angina epidemica - 353 






CHAPTER X. 



TYPHUS EPIBEMICUS, OR CONTINUED FEVER. 

Sect. 1. Preliminary observations - 356 

2. Symptoms - . - 362 

3. Treatment - - - 366 

Remarks on Pulmonary Consumption - 378 



PRELIMINARY. 

Should some fastidious critic demand an apology of an 
obscure individual, for publicly approaching the impor- 
tant subjects of the following sheets, he may receive for 
answer ; first, because nothing is more needed ; and 
secondly, because the subject has been neglected by those 
better qualified. 

The writer has long been fully impressed with a con- 
viction of the necessity of some system on epidemic dis- 
eases, which would exhibit, in a short and conspicuous 
view, their theory, and help to harmonize the vague and 
adverse practices, discoverable throughout the country, 
originating from a too successful promulgation of absurd 
and visionary theories, not conducive to practical utility. 
But that this task should devolve upon him, was not con- 
templated until the autumn of 1813 ; when making a jour- 
ney to Philadelphia, he discovered much anxiety among 
the gentlemen of the faculty in that quarter, to obtain 
more particular information respecting the late northern 
epidemics. It was their right to expect, and the privilege 
of the world to receive, at least, the historical part. The 
chief regret of the author is, that the attempt is not ren- 
dered more complete. 

2 



1. 



AKT. 







PRELIMINARY. 11 

method is pursued : thereby confounding right with 
wrong, correctness with errour, and truth with falsehood. 
The functions of animal life in health and sickness, are 
governed by laws, although of a different kind, vet as 
immutable as the affinities of inert matter. The unex 
pected and unintelligible phenomena of living bodies in 
disease, arise not from the capricious freaks of nature, 
but have an origin in mental and corporeal influences, 
with as much correctness, as ponderous bodies are sub- 
jected to the law s of gravitation. 

If these positions are true, the too much neglected 
science of physiology* appears, in the majesty of its dig- 
nity, to assert its station in the first rank of medical 
acquirements. However useful a knowledge of chemis- 
try, materia rnedica, anatomy, and other elementary stu- 
dies, may be to the medical student, yet without a know- 
ledge of physiology, he is no better prepared to practice 
medicine, than the artist who framed the instrument, 
would be to harmonize melodious symphonies, who had 
never taught his fingers to dance on the keys of a piano 
forte. 

He who practices without these superior acquirements, 
can be nothing but a servile imitator, and puts himself 
upon a level with the veterinary scrubber, or the garru- 
lous patentee; alike ignorant of his catholicon as of the 
character of the disease, he still expects some wonderful 

* By this is meant, not only the physiology of nature 
but the physiology of experience and observation. 

Cor vis art 



12 PRELIMINARY. 

specific effect from his sovereign mercurial, or his impe- 
rial opiate. 

Physicians, like all other characters, are liable to vi- 
brate from one extreme to the other, and may sometimes 
be led by fashion. "We see the Sydenhamic practice, 
which was instituted for the cure of sthenic eruptive dis- 
eases, gain the ascendency. So effectually had it obtain- 
ed, that, notwithstanding our country has long been 
infested with fevers of internal irritation, and external 
debility, the revival of the sweating and alexipharmic 
treatment in spotted fever was left to a heroine in medi- 
cine, Mrs. Hurlbert. This was not peculiar to the place 
where she resided. It was a very common practice to 
advise cool applications to the surface in typhus fever, 
dysentery, &c. for a long period before the spotted fever 
visited this country, and is still persisted in by many. As 
in popular assemblies, a few characters direct the desti- 
nies of an empire ; so in medicine, a select influential 
few prescribe for a nation. 

On the other hand, the alexipharmic treatment, in 
opposition to the refrigerant plan, was really useful in 
certain states of the system, called malignant ; meaning 
those conditions of fever, where the responding action of 
the system with great difficulty obtains upon the surface 
of the body and extremities, attended with appearances 
of debility, and which are marks of the highest grade of 
diseased impressions. Being found useful in this condi- 
tion, under certain circumstances, it was often used indis- 
criminately, and without proper auxiliaries ; and, from 
the circumstance of its injudicious application, lost its 



PRELIMINARY. IS 

reputation, and has been long neglected in this country, 
until revived in the late petechial fever. The scene has 
been reacted here that was acted in the days of Morton 
and Sydenham in the city of Loudon. 

Were it left to the writer to decide, he would be at a 
loss to determine which of these two great divisions, that 
chiefly compose the medical world, merits the greatest 
censure: the one, for extending the refrigerating prac- 
tice beyond its natural limits, to diseases of extreme tor- 
por of the surface, and without discrimination ; — and the 
other for carrying the stimulating and sweating practice 
to excess, whilst neglecting auxiliaries, also without 
discrimination. 

A work that would combine the advantages of these 
diverse theories, connected with practical and physiolo- 
gical illustrations, and thus establish a rational method 
of treatment, must be considered a valuable acquisition 
to the inexperienced practitioner. Whether such a sys- 
tem has ever been published is unknown to the writer ; 
but of this he is assured, that no such has ever come 
to his knowledge. How far the following brief sketches 
will answer these purposes, and the promotion of useful 
information, must be submitted to the decision of a can- 
did public. 

To bring the subject fairly into view, a method was 
settled upon, which at present is most satisfactory to the 
author, and which it is hoped will gain the approbation 
of the reader. It has been inculcated by the great mo- 
dels of the science, that every treatise on epidemic dis- 
eases should be preceded by a topographical sketch of 



14 PRELIMINARY. 

the country wherein they have prevailed. This cannot 
be so interesting to the inhabitants of the state described 
as to others. 

A condensed view of the periods and importance of 
past diseases, must be acceptable to the present genera- 
tion, and a precious relic for posterity. 

In chapter iii. will be found a collected epitome of the 
most valuable opinions of modern physicians on the 
causes of fever, with the author's peculiar views and 
illustrations. If any should be dissatisfied with these, 
he will be at liberty to do more justice to the subject. 

In chapter iv. is an unfinished attempt to explain, in 
a very obvious and familiar manner, some of the pheno- 
mena of fever. This subject has always, and justly, been 
considered very difficult ; some latitude may therefore be 
given the writer, especially when it is considered, his 
object is more to practical improvement, than a meddling 
with physiological entanglements, or an adoption of that 
kind of phraseology, which is often misunderstood by the 
best classic scholars. 

In chapter v. by putting the diagnosis and treatment 
of fever in a new point of view, marking the various 
grades of fatal tendency, and turning the attention par- 
ticularly to the sequelae of fever, it is hoped the appro- 
bation of the reader will be gained after a patient perusal. 

Chapters vi. vii. viii. ix. and x. on particular diseases, 
are offered the reader without any further comment, than 
that if he could have treated them to his satisfaction 
by following the fashionable prescriptions of the day, he 
would not have offered his own views on the subject. It 



PRELIMINARY. 15 

is hoped here and every where else, it will be under- 
stood, that if any severity should be discovered, it is 
intended to be applied to principles, and not to charac- 
ters. 

The remarks on consumption are respectfully offered 
for the consideration of the discriminating physician. A 
summary conclusion is offered of those investigations, 
which were excited by an evident constitutional propen- 
sity to the disease in himself, and the loss of several of 
his nearest connexions by it, under the common regimen. 
Perhaps the theoretical part may appear rather novel, 
and seem to merit criticism ; but the author will always 
find consolation in looking at the motto at the head of the 
chapter, and particularly, as it will revive the recollec- 
tion of the worthy character who penned it. 

The writings of others, and particularly certain Ame- 
rican publications on epidemic diseases, are duly appre- 
ciated and acknowledged to be of great merit. Many of 
these have been perused with much interest; and have 
been of service in encouraging the writer in the use of 
energetic applications, to arrest the progress of disease, 
which otherwise, oftentimes, might have a sudden and 
unfavourable termination. — But those systems and prac- 
tices, which savour so much of the obsequious, imitative, 
and temporizing methods, as to suffer almost every case 
to be protracted to an unnecessary length, and dubious 
termination, are held in disapprobation. 

It will be noticed, that more attention is bestowed upon 
general principles in the work, than upon the minutise of 
practical applications. A single volume is not sufficient 



16 PRELIMINARY. 

to answer the former design, and admit great variety in 
the methodus medendi. The discretion of the reader 
can add or alter particular remedies to suit his own 
judgment, in conformity to general principles. Also the 
quantities of remedies are almost wholly left out. The 
design of this must be obvious. If the student has not 
learned these, he may find them in the proper books. 
And further, as in every instance, the quantities of reme- 
dies should be regulated by the quantity of excitement in 
the diseased system, so the force of the former should be 
levelled in such a manner as to suit the exigencies of the 
latter. 

With the same view, the quantity of blood that might 
be lost is rarely mentioned ; but rather, the number of 
repetitions. A full bleeding is considered to be such a 
quantity, as makes souie sensible change in the action of 
the heart and arteries, and the number will depend on the 
obstinacy of the disease, and frequency of recurrence of 
that state, which first required this operation. 

It will be further noticed, that very little addition is 
made to the numerous recipes of heterogeneous mixture 
already extant. When the primary and preternatural 
changes in the system, constituting disease, are traced to 
their origin, and deprived of collateral and secondary 
consequences, they appear very simple ; they may be met 
with very simple remedies. But if every symptom is to 
be combated by some specific drug, the Theriaca of An- 
dromicus will not contain enough. 

If it should be objected, that too great sameness and 
simplicity of applications are apparent ; it will be answer- 



PRELIMINARY. 17 

ed, that the necessity of the subject compels to it ; and 
it is agreeable to the design to disrobe the therapeutical 
as well as the theoretical part of complication and mys- 
tery. As in religion, the far-fetched and fine spun web 
of metaphysical dogmas are often neither understood, 
nor consoling to the weary and heavy laden ; and as in 
jurisprudence, the complexity attached to rights and 
wrongs, often strains the cords of justice to oppression; 
so the multifarious and contra prescriptions of the phy- 
sician may become too burdensome to a patient already 
tottering under the weight of disease. 

The copiousness of the design, and the limited condi- 
tion of the work, have precluded an opportunity of intro- 
ducing the testimony of respectable authors, in certain 
instances, and the opportunity of illustrating certain pro- 
positions by facts and argument, and also that of opposing 
others. Simplicity, perspicuity, and brevity, are chiefly 
aimed at. But some apprehension is entertained, that the 
laconic style, in some places, might possibly leave the 
subject without sufficient explanation. 

Most of the subjects treated of must be considered as 
difficult, and accustomed to be controverted. Some lenity 
will be granted, when it is considered, that for want of 
sufficient evidence, some opinions advanced must be more 
or less speculative. The author, therefore, will not be 
considered as chargeable any further, than for his own 
opinion and for matters of fact. Whenever evidence 
shall be adduced to warrant a change of the former, or 
correction of the latter, he will consider it his highest 
privilege to conform thereto. 

3 



18 PRELIMINARY. 

But little methodical arrangement has been attempted, 
and subjects are treated with freedom, as they occurred 
whilst writing. What is now advanced, may rather be 
considered a skeleton, or sketches of a system, which pos- 
sibly hereafter, if fostered by the care and friendly influ- 
ences of genius and observation, may grow into a system 
highly useful. 

In the first period of practice, after traversing the 
paths of disappointment, the writer imbibed a disrelish 
for books, and laid them mostly aside for several years. 
Probably this might have diminished the scientific im- 
provement which otherwise might have been made. But 
still the belief remains, that, by some dissections, an un- 
ceasing attention to the phenomena of disease, and the 
varied action of the diseased system under the operation 
of remedies, a familiar acquaintance was obtained with 
those of more importance in a practical point of view, 
than would have been acquired by any laborious research 
of the records of antiquity, or the numerous speculations 
of modern times. 

The writer will not challenge originality; but he hopes 
independence of thinking will not be denied him. Many 
of the sentiments advanced are in strict conformity to 
authors of the first respectability. As the writer is more 
in the habit of thinking than reading, he is at a loss as to 
some particular sentiments, whether he had ever seen 
them advanced by others, or whether they were the re- 
sult of his own reflections. Some of them, however, he 
is confident, he never knew advanced by others. 

The design of the work was not planned nor begun 
until May last; and for a considerable time, much hesi- 



PRELIMINARY. If 

tat ion remained as to the propriety and expediency of 
w venturing on that sea of troubles, which none but au- 
thors know." At length duty prevailed over ease, and the 
hope of being useful, over the dreaded sickness of chagrin 
and disappointment. The subject is copious ; it is pro- 
lific ; much remains to be done. It must be given to the 
press as it is, or wholly suppressed. 

It is said a book once published is irrevocable. The 
writer will not complain ; but, the short term of nine 
months, and not half of it spent in the work ; the frequent 
interruptions occasioned by practical avocations ; a mul- 
tiplicity of domestic concerns; a time when political 
difficulties agitate the minds of most people; writing 
within sound of a military rendezvous ; and lastly, the 
embarrassments connected with frequent interruptions of 
health, might, on any other occasion, serve as apologies. 
But none will be made ; nor can any be received on sub- 
jects like these. Nothing but honest candour can be 
expected in necessary criticism. If in the collision of 
opinion, truth should be elicited, the writer will enjoy 
the satisfaction, of not having lived in vain. 

Woodstock, Vermont^ February, 1815. 



CHAPTER I. 

CONCISE TOPOGRAPHY OF THE STATE OP VERMONT. 

In the first design of the work, it was contemplated to 
exhibit a topographical view of the state, which perhaps 
might have been in a measure complete and satisfactory. 
This subject was delayed until the last ; and two reasons 
compel a relinquishment of the plan in part. The first is, 
neglect of obtaining particular information ; but princi- 
pally, that the work is already extended beyond its pre- 
scribed limits. A very cursory and superficial view will 
only be attempted. 

The territory is situated, between 42 degreees 45 min. 
and 45 deg. north latitude ; and 3 deg. 45 min. and 5 
deg. 25 min. east longitude from Washington. 

It is bounded on the south by Massachusetts ; on the 
north by Lower Canada ,• on the east by the western bank 
of Connecticut river, which separates it from New Hamp- 
shire ; on the west by the middle waters of Lake Cham- 
plaine, and a part of the state of New York. It is divid- 
ed into thirteen counties ; and subdivided into about 240 
towns, of six miles square. Population, in 1800, was 
154,449 ; and in 1810 was 217,915 inhabitants. 

The soil is fertile, and suitable for the purposes of 
agriculture, and the production of vegetation of all kinds, 



22 TOPOGRAPHY. CHAP. I. 

as in latitudes of similar temperature. The soil is gene- 
rally of a deep and dark colour, moist and loamy. This 
is particularly the condition in valleys, meadows, and 
in ground moderately inclining ; on the highest parts of 
hills, the soil is frequently more shallow, gravelly, and 
dry. But few eminences are so much so as to be unfit 
for cultivation ; and in many places, the sides and tops of 
hills are considered the best for ploughing and for grain. 

The bases of the mountains, and often some distance 
upwards, furnish a rich soil, very productive of grass ; 
but the summits of mountains are not worth cultivation, 
on account of the elevation^pproaching a higher and 
colder region of atmosphere, and from the abundance of 
rocks and sterility of soil. None of the mountains are 
so high, but that the tops are generally covered with 
trees and shrubbery of evergreens. This circumstance 
gave rise to the name of the Green Mountains, and from 
these the name of the state, Ver Mons, Vermont. 

The mountains are the largest in the southern and 
middle parts of the state. A chain of mountains ex- 
tends from the southern boundary to Onion river, in a 
line nearly occupying the centre of the state. At the 
northward of this river they dwindle until they seem 
but hills of considerable magnitude, generally fit for 
cultivation ; they are covered with hard wood, and 
when cleared, are very productive of grass. From the 
highest land east and west, the face of the country 
is broken into hills of different height and magnitude ; 
exhibiting a grotesque and romantic appearance of" or- 
derly confusion." Notwithstanding they are generally 



CHAP. I. TOPOGRAPHY. 23 

habitable and prolific in vegetation. The height of 
Killington peak, between this place and Rutland, as com- 
puted by Mr. Williams, is 3i5i feet above the water at 
Quebeck. The altitude in this latitude, at which perpe- 
tual congelation takes place, is about 8066 feet above the 
level of the sea, as at Quebeck. The peak is the highest 
land in the state; of course none of the mountains are 
fixed in continual frost. 

The numerous streams and rivers which run from the 
height of land on the east into Connecticut river, and on 
the west into lake Champlain, are connected in their 
course, with meadows of greater or less extent, very 
pleasant, rich, and productive. On the east side of the 
state, the Connecticut washes and enriches a large por- 
tion of meadow, hardly inferior to any in America. On 
the west, lake Champlain is surrounded with a wide 
extent of tolerably level country, which being overspread 
with a marly and calcareous soil, is noted for the culture 
of wheat. 

From the mountains and hills issue numerous springs 
of as clear and pleasant water, as any country can boast 
of. This is particularly the condition in the eastern 
part ; some exceptions may be made in that part adja- 
cent to lake Champlain. Near this, the water is less 
rapid in its course, and percolating through beds of iron 
ore, and washing a marly and calcareous soil, receives 
impregnations from these, and becomes more or less 
unfit for use. The springs and rivers almost constantly 
afford a transparent water, in which soap is readily mis- 
cible,and consequently suitable for the purpose of wash- 



Vk TOPOGRAPHY. CHAP. I. 

ing and other culinary uses. It is very common, how- 
ever, for the water of wells to contain carbonated lime, 
which renders it hard, unfit for washing, and produces 
an incrustation upon the inside of tea-kettles. I have 
never been able to discover, that the constant use of this 
water induces any disease, more than the use of water of 
the softest kind. 

At various places in different parts of the state, springs 
have been discovered, having slight impregnations of 
mineral bodies ; the medicinal qualities of these have not 
yet been discovered sufficiently to bring them into any 
considerable use. 

The numerous rivers and large brooks, which descend 
from the height of land east and west, are interrupted in 
their course with many falls or cascades of romantic ap- 
pearance : these are of great use in offering sites for 
mills, forges, manufactories, &c. 

Besides lake Champlain on the west, lake Memphre- 
magog on the north runs a few miles into the state ; and 
also many small ponds are found in different places. 
Low, dead, or sunken land is scarcely found in any part 
of the state, except in the vicinity of Champlain ; and 
even here it is not very extensive ; enough, however, to 
affect the inhabitants with intermitting fevers. Except 
in this part of the state, intermitting fevers are not met 
with. 

On the east, in the town of Strafford, has lately been 
discovered a bed of copperas, which has been worked to 
some advantage. In the western part of the state are 
many beds of iron ore, which have been worked to great 
advantage for many years ; but none on the eastern part 



CHAP. I. TOPOGRAPHY. 25 

sufficient to encourage the establishment of manufacto- 
ries. In the town of Monkton has lately been discovered 
an extensive bed of clay, which is thought suitable for 
the manufactory of porcelain ware. This town is noted 
for its iron works. Large quantities of spurious marble 
are worked at Middlebury. Lime stone of the best 
quality is found in abundance in the western part of the 
state, and on some of the mountains, especially in Ply- 
mouth, where it is largely prepared. Many geological 
facts must be passed unnoticed. 

A drought is rarely experienced in Vermont. The 
harvests often suffer more in the latter part of the sum- 
mer and autumn, from too much rain than from a scan- 
tiness. The summer rains usually commence about the 
20th of July, which sometimes are a great hindrance to 
securing hay and grain. The autumnal rains commence 
about the 20th of October. A great part of the year, 
the air is dry, pure, and serene, not attended with the 
mists and fogs so frequent in some places. Tin does not 
rust exposed to the air ; nor do books contract mould. In 
the heat of summer and beginning of autumn, thick fogs 
arise in the evening in calm weather from Connecticut 
river, lake Champlain, and other large bodies of water, 
and continue from one to two hours after sunrise. I have 
not been able to discover that these fogs predispose the 
inhabitants to disease of any kind. 

Snow falls sometimes in October, more frequently in 
November ,• not usually, however, to continue through 
the winter, until about the middle of December. Some 
winters are amended with thaws, which melt the snows, 

4 



26 TOPOGRAPHY. CHAP. I. 

and produce freshets. It is more common, that snow 
continues sufficient for good sleighing until the 20th of 
March. The snow is commonly ahout two feet deep in 
the winter, sometimes one, and sometimes three. These 
observations are more particularly applicable to the 
eastern section of the state, and the height of land. In 
the western part, and especially contiguous to lake Cham- 
plain, there is often such a scantiness of snow as to ren- 
der sleighs useless, whilst it is very plenty in other parts 
of the state. 

The white pine, the loftiest tree of the forest, grows in 
abundance on the banks of Connecticut river. It is the 
principal wood for about three miles from the river. 
Also the same ground is interspersed with white oak, yel- 
low pine, black oak, butternut ; in some places, walnut, 
chestnut, &e. The lowest flats or meadows are covered 
principally with the last mentioned timber, the pines of 
different species growing on the highest flats, adjacent 
hills, &c. The pine is found in great quantities in the 
neighbourhood of lake Champlain, and in considerable 
quantities on the banks of all the smaller rivers. The 
medium upland is covered with the sugar maple, white 
maple, beech, birch, white ash, black ash, basswood, 
hornbeam, cherry, butternut, elm, poplar, some hemlock, 
&c. The highest hills and mountains are adorned with 
evergreen trees, such as hemlock, spruce, fir tree ; to 
which may be added the cedar, hackmetaek, juniper. &c. 

With respect to the course of the winds, a more satis- 
factory account cannot be given, than the observations 
made at Burlington, from 1803 to 1808. In 1652 obser- 



CHAP. I. TOPOGRAPHY. 27 

vations, the wind was from the north 739 times ; from 
the south 826 ; from the east 19 ; from the west 43 ; 
from n. e. 11 ; from the s. e. 1 ; from the n. w. 18 ; from 
the s. w. 25. It may he observed that the eastern part 
of Vermont is more exposed to the n. e. winds, than the 
vicinity of lake Champlain, and they are here more ex- 
perienced. Thunder showers in summer most common- 
ly come from the west or south-west. 

From observations made at the same time and place, 
by President Sanders, it appears, that the mean tempe- 
rature of climate for five years was, for January 14° 4 ; 
February 18° 9 ; March 28° 5 ; April 39° 5 ; May 56<> 3 ; 
June 66° 6 ; July 68<> 2; August 67° 6 ; September 57° 
1; October 45° 2; November 33° 5; December 24° 7. 
The mean temperature of the air for the year was 43 
and one third ; and at Rutland 43° and one half; and 
this corresponds with the constant temperature of the 
earth in the same places, at 20 feet below the surface. 

From 1701 observations of the weather, at the above 
time and place, the result appears to stand thus ; 1025 
fair; 676 cloudy; 289 rain; 117 snow; 19 fog; 45 thun- 
der ; 27 aurora borealis ; hail and hazy none. See Wil- 
Harris's History. 

The effect of cutting off the timber, and cultivating 
the soil, appears to be, to diminish the quantity of cold. 
The winters are not so severe, nor the snow usually so 
deep, as in the first settlement of the state. 

Frost commonly ceases about the 15th of May; and 
again commences about the 10th of September. The 
seasons are sometimes varied about two weeks from their 



28 TOPOGRAPHY. CHAP. I. 

usual course. Apple trees bud about the 20th of April ; 
put forth leaves about the 1st, and show their blossoms 
about the 10th of May. Indian corn is commonly plant- 
ed about the 12th of May, flowers about the middle of 
July, and is usually harvested the fore part of October. 
In the northern section of the state above the latitude of 
44°, Indian corn seldom arrives to perfection, unless on 
meadow lands. 

The fertility of the soil amply repays the labourer for 
his toil and care. The industrious farmer is very sure 
to have his barns filled with the best of hay and flax, 
his granaries with the choicest wheat, rye, corn, oats, 
barley, peas, beans, &c. : and his cellar crowded with ci- 
der, potatoes, and esculent vegetables, the effect of hor- 
ticulture. 

The country abounds in neat stock, horses, sheep, 
swine, poultry, &c. The beef and mutton of Vermont 
are not inferior to any in the union. Crossing the for- 
mer flocks of sheep with the merino breed, promises 
advantage to the country. 

The state was principally settled by emigrants from 
the neighbouring states, and some foreigners. The as- 
sociation in society is too short to assume a distinct 
national character ; the predominant cast is English, in 
language, manners, customs, and habits. 

The Vermonters, as a people, are respectful of reli- 
gion ; hospitable, liberal, industrious, and enterprising : 
tenacious of their rights, and fond of republican govern- 
ment. The minds of the youth are improved by educa- 
tion with nearly the same assiduity that their bodies are 



CHAP. I. TOPOGRAPHY. 29 

nourished with the fruits of the earth. But without an 
opposite there can be no contrast. As disease invades a 
foVi whilst health smiles upon many; so immorality, 
perfidiousness, and treachery, mark individuals for their 
own. 



But little attention has been given to Botany in this 
region ; a wide field is opened for some disciple of Lin- 
naeus. The following imperfect catalogue of indigenous 
vegetables, and such as grow spontaneously, and are used 
more or less medicinally, is offered as the best at hand. 

Agrimonia, Agrimony. 

Adianthum, Maiden-Hair, 

Angelica Sylvestris, Wild Angelica. 

Acorus Calamus, Sweet Flag. 

Aralia Racemosa, Spikenard. 

Aralia Spinosa, Prickly Ash. 

Artemisia Absinthium, Wormwood. 

Arum Triphyllum, Dragon Root. 

Abies Balsamea, Fir Balsam. 

Arthritica, Ground Pine. 

Bardana, Burdock. 
ChenopodiumAnthelminticum,Oak of Jerusalem. 

Cinchona Spuriosa, Spurious Bark. 

Conium Maculatum, Cicuta. 

Convallaria Polygonatum, Solomon's Seal. 

Eupatorium Perfoliatum, Thorough Wort. 

Filix Dulcis. Sweet Fern. 



30 TOPOGRAPHY. 

Gramen Polygonatum, Knot Grass. 

GeumRivale(cary ophyllata,) Avens Root. 



chap. i. 



Panax Trifolium, 
Haniamelis Virginiana, 
Hepatica Nobilis, 
Inula Helenium, 
Imperatoria, 
Juglans Cinerea, 
Juniperus Sabina, 
Lapathum Acutuni, 
Laurus Sassafras, 
Leontodon Taraxacum, 
Leonurus Cardiaca, 
Lobelia Inflata, 
Marubium, 
Millefolium, 
Mentha Viridis, 
Mentha Borealis, 
Mentha Piperita, 
Nymphsea, 
Nepeta, 
Nigella, 

Oxalis Acetocella, 
Phytolacca Decandra, 
Plantago, 
Polypodium, 
Populus Balsamifera, 
Polygala Senega, 
Prinos Verticillatus, 
Prunus Virginianus, 



Ginseng. 

Witch Hazel. 

Noble Liverwort. 

Elecampane. 

Master Wort. 

Butternut (the extract.) 

Savine. 

Sharp-pointed Dock. 

Sassafras. 

Dandelion. 

Mother Wort. 

Lobelia (Indian Tobacco.) 

Horehound. 

Yarrow. 

Spear Mint. 

Horse Mint. 

Pepper Mint. 

Pond Lilly. 

Cat Mint, or Catnip. . 

Golden Thread. 

Wood Sorrel. 

Garget. 

Plantain. 

Hog Brake. 

Balm of Gilead. 

Seneca (rattlesnake root.) 

Black Alder. 

Black Cherry Tree. 



CHAP. I. 

Pinus Canadensis, 

Quercus, 

Rhus Copallinum, 

Salix Rubra, 

Sambucus Ebulus, 

Sanguinaria, 

Sanicula, 

Solanum Dulcamara, 

Smilax Sarsaparilla, 

Scandix Odorata, 

Spirea Trifoliata, 

Serpentaria Nigra, 

Symphytum Officinale, 

Tanacetum, 

Tussilago, 

Ulmus Fulva, 

Urtica, 

Veratrum Album, 

Virga Aurea, 

Verba scum. 



TOPOGRAPHY. 31 

Hemlock Tree (gum.) 

Oak (the bark.) 

Sumach. 

Red Willow. 

Dwarf Elder. 

Blood Root. 

Sanicle. 

Bittersweet. 

Sarsaparilla. 

Sweet Cieily. 

Indian Physic. Ipecacuanha. 

Black Snake Root. 

Comfrey. 

Tansy. 

Coltsfoot. 

Slippery Elm. 

Common Nettle. 

White Hellebore, Poke root. 

Golden Rod. 

Mullein. 



CHAPTER II. 

HISTORY OF EPIDEMIC DISEASES IN THE STATE OF 
VERMONT. 

The settlement of the state of Vermont must be con- 
sidered as very inconsiderable at the close of the English 
and French war in 1763. From that time to the war 
between Great Britain and the American colonies in 
1775, considerable progress had been made by numerous 
adventurers. A large number of inhabitants migrated to 
this state during the revolutionary war, but it was not 
until after the peace of 1783, that very important esta- 
blishments were made. 

The diseases previous to the last mentioned period 
were in common with those of the adjacent territories. 
Dysentery was universally epidemic in 1776 and 1777. 
At the same time it made great havock in the army at 
the capture of Burguoyne, in 1777, and prevailed general* 
ly in the New England states. The American army 
near lake Champlain suffered severely. 

Nothing is more foreign from the truth, than the 
assertion, that this disease was communicated from one 
person to another, or that it was contagious. At the very 
time it prevailed in the American army, it also prevailed 
in different remote places, and even in the new settle- 
ments of Vermont, with great severity. It proved very 

5 



34< HISTORY OF DISEASES. CHAP. II. 

mortal in many places. From all the information I have 
been able to obtain, and from a faint recollection of the 
symptoms, I am convinced the disease was of a very 
similar character with epidemic dysenteries, that have 
since prevailed in the state. 

In the spring of 1781 a catarrhal fever prevailed. It 
was not fatal, but in few instanees. 

In 1782 dysentery prevailed in some places only. Dr. 
Huntington informs me, that it was very frequent in the 
county of Bennington, in August and September, but not 
very mortal. 

" Between the years 1773 and 1777, the malignant 
sore throat appeared in several towns, and at several 
different periods in the state of Vermont, and proved 
fatal to many children. During the latter part of the 
period, the measles became very general, and were, I 
believe, very inflammatory ." 

66 During the revolutionary war, and especially toward 
the latter part of it, people were much affected with an 
eruption, called by some the ground itch ; it being sup- 
posed, that it originated with the soldiers, who contract- 
ed it by lying on the ground." Letter from Prof. JV*. 
Smith Hanover. 

In the winter of 1786, pleurisy was very frequent in 
the vicinity of Shaftsbury. 

From 1783, the close of the American war, to 1790, 
prevailed various diseases, which, if they do not mark 
the intervening period with very serious calamity, were 
however very severe in proportion to the number of inha- 
bitants. The scarlatina, or malignant sore throat, was 



OHA.P. II. HISTORY OF DISEASES. 35 

very prevalent almost the whole time, hut iu different 
places in different periods of the term. It is particularly 
spoken of by one correspondent, as prevailing between 
the years 1787 and 1790. It was very fatal in many 
places. It severely affected the inhabitants in the wes- 
tern part of New Hampshire, during this period. I am 
not in possession of any evidence to show, that the sore 
throat of this period, was, in any respect, different from 
that which has since prevailed. 

A circumstance, mentioned by Mr. Webster on the 
disease of this period, is of consequence in proving a ge- 
neral pestilential state of the atmosphere, as necessary 
for the spread of epidemic diseases. " This pestilential 
constitution was felt in the north of Europe. The scar- 
latina broke out in Edinburgh in the winter of 1782 — 3, 
a few weeks before it did in America ; but of its progress 
I have no account. It appears to have been epidemic in 
London in 1786 ; so that its period was of about the same 
duration as in America. The contemporaneousness of 
this species of disease in Great Britain and America, 
deserves particular notice." 

During this period canine madness was very frequent. 
Dogs, wolves, foxes, and cats, were said to be affected. 
In Barnard, a Mr. Stewart was bitten by a mad wolf, on 
the 17th of March, 1784. The wound was in his face. 
Twenty-seven days after the accident, he was attacked 
with symptons of hydrophobia, and died in three days. 
His son had a slight wound at the time, by the same ani- 
mal, on his arm ', he had symptoms of the disease in SO 



36 HISTORY OF DISEASES. CHAP. II. 

days, but recovered. I am not furnished with the parti- 
culars of his sickness. 

The canker rash was epidemic in the western part of 
the state, in the winter of 178? — 8. 

The various and common diseases of the country con- 
tinued to prevail during this period as usual, such as 
pleurisy, inflammatory fevers, some partaking more dis- 
tinctly of the typhus character, others bilious or inter- 
mittent, dysentery, cynanche trachealis or croup, colics, 
consumption, ophthalmia, rheumatism, puerperal fe- 
ver, &e. 

In 1788, dysentery was very considerably prevalent in 
different parts of the country. Dr. Huntington remarks, 
in speaking of the epidemic diseases in the county of 
Bennington, " but few families escaped that dreadful 
disease, and many died in different towns." Bennington 
and the adjacent towns are situated on high mountainous 
ground. I would here observe, that when this disease 
prevails epidemically, I have never been able to discover 
any difference in the frequency or fatality of it on the 
highest habitable hills, and the lowest valleys. Neither 
are the symptoms different, nor, in my opinion, does it re- 
quire any difference, on that account, in the treatment. 
I have thought, that at such times when it prevails, it 
seizes with equal severity those situated free from any 
visible local miasmata as those situated in the atmos- 
phere of such supposed influences. In September, 1796, 
I was witness to as severe a dysentery as I ever met with, 
in a neighbourhood of Stockbridge. It was situated on 



CHAF. II. HISTORY OF DISEASES. $7 

high and fair land, and no local impurity could be disco- 
vered to my understanding. 

In the autumn of 1789, the latter part of October and 
the beginning of November, the influenza became almost 
universally epidemic. It was, perhaps, as extensive influ- 
enza as ever affected the people of this country ; scarcely 
a person was exempted from it, in a greater or less de- 
gree. In some, it was very severe, amounting to pneu- 
monia, and proved fatal in some instances ; but, consider- 
ing the number affected, it was far from being a severe 
disease. All, who had it, were troubled with cough and 
soreness in the throat and lungs, defluxion of humours 
from the nose, and spitting of phlegm. Moderate symp- 
toms of fever, such as cold chills, pain, weakness, quick- 
ness of pulse, &c. 

In the winter of 1788 — 9, the measles were very gene- 
rally epidemic. The disease did not seem to have any 
unusual symptoms ; but many cases were followed by 
consumption. This may fairly be considered the effect 
of neglect or bad management ; for if blood-letting and 
antiphlogistic remedies are thoroughly persisted in, the 
disease is not followed by any such malady. 

In October and November, 1788, a comet appeared. 
Something of a scarcity of provision was experienced 
in the year 1789, in Vermont, Connecticut, and some 
other New England states; but none greatly suffered. 
The statement of Mr. Webster was news to the people 
here, that, " In Vermont the people were reduced to the 
necessity of feeding on tad-poles and pea-straw boiled 
with potatoes. In one instance, four potatoes were sold 
for nine pence." ! ! 



38 HISTORY OF DISEASES. CHAP. II. 

1790. 

The diseases of the winter of this year, were nothing 
different from what is common, except, that in many 
places, the pestilential influence, which caused the in- 
fluenza, seemed to produce a greater number of dis- 
eases of the lungs than usual. In the spring, the influ- 
enza again appeared, and became very general. At this 
second appearance, after being so general the fall before, 
it was attended with a greater degree of inflammation in 
the lungs than was produced the autumn preceding. A 
correspondent observes, at this time, « It fell more upon 
the lungs, and proved fatal to many, and exhibited symp- 
toms, like the late epidemic affections of the lungs, but 
of a milder form. The patients, who died of it, lived 
longer after the attack, than they did in the winter of 
1812—13." 

As severe pneumonic affections are very commonly 
preceded by influenza, it may be suggested, that probably 
this second appearance of this disease, by some favourable 
change in the elementary principles, took place instead 
of severe pneumonia, or some other fatal epidemic. 
The pestilential state of the atmosphere is generally 
progressive ; slighter diseases appear at first ; but this 
is not invariable ; salutary changes may take place, and 
that state of atmosphere, which would have produced a 
fatal pneumonia, in a state of rapid progression, might 
produce nothing but a severe influenza, in a slow pro- 
gression. 



CHAP. II. HISTORY OF DISEASES, 39 

1791. 
This year may be considered pretty healthy. I have 
no information, nor any minutes of any epidemic pre- 
vailing this year; except one correspondent remarks 
some prevalence of the measles. 

1792. 

This year also was free from severe diseases of any 
particular epidemic character, or as prevailing in a 
general and severe manner. Notwithstanding, the sum 
total of sickness is very considerable in the most healthy 
seasons. 

1793. 

Diseases of various descriptions began to assume a 
more serious aspect this year, than for some years past. 
Inflammatory fevers, or what were called by some 
bilious, were considerably frequent. The malignant 
sore throat, or canker rash, began in various places this 
year ; as in the south part of Vermont, in New York, 
Massachusetts, Pennsylvania, &c. but did not appear at 
Bethel, where I then lived, until two years after. By 
advice from Doctor Littlefield, of Arlington, it appeared 
in this place, Landgate, and Salem, this, and the follow- 
ing years, considerably mortal in some neighbourhoods. 

1794. 
Nothing very remarkable occurred this year, respect- 
ing the spreading of any severe epidemic, in this vicinity. 
It may be remarked, that almost all diseases of pyrexial 



40 HISTORY 0* DISEASES. CHAP. II. 

character, became more severe than they had been for a 
few years past. A few cases of sporadic fever with 
anomalous symptoms, terminated fatally in a short time. 
Typhus fever is said to have prevailed in the vicinity 
of Bennington and adjacent places. Perhaps fevers, 
here at that time, might as well have been called ty- 
phus ; the difference is nothing very important. They 
were often denominated nervous or slow fevers; but 
when they prevail very considerably, they are said to be 
contagious. This circumstance has deceived more or 
less people, in all ages, and in all diseases. Influenza 
had a spread this year in its usual manner ; not so severe 
as some of later years. 

1795. 
In the winter of 1794-5, an epidemic pneumonia pre- 
vailed, or as it was called, pleurisy. It was attended 
with severe pain in the side, cough, fever, some spitting 
of blood, and other symptoms common to that disease; 
as also symptoms of oppressed action common to severe 
epidemics. It commenced in Jauuary, in the county of 
Windsor, and continued till April. In some places. 
it was considerably mortal. Much, in this respect, 
depended on the treatment. It was frequently con- 
nected with a small oppressed pulse, paleness, &c. 
Where blood letting was omitted, and reliance placed on 
opium and other stimulants, as also salivation, as prac- 
tised by some, the disease became unmanageable. When 
treated with free bleedings, sweating, blistering, and 
antiphlogistic remedies, it became, for the most part, 
very manageable, 



CHAF. II. HISTORY OF DISEASES. *1 

This disease seemed to be connected with the other 
epidemics, that prevailed at this period. Nothing is 
more common than for one epidemic to be changed into 
another form of appearance, by a change of local affec- 
tion, either, from a change of (he predisponent princi- 
ple, or by a change of season or other circumstances. 
The malignant sore throat, or scarlatina, or rather 
angina epidemica, had been in other parts of the coun- 
try for two years. The next winter after, the pleurisy 
appeared in this vicinity, the scarlatina raged with much 
violence in some places, previously occupied by the pleu- 
risy. If I am not greatly mistaken, these two diseases 
were contemporaneous in some places. 

In the autumn of this year, the ulcerous sore throat, 
or angina, began to appear in the county of Windsor, or 
in that part of it, situated on White river, particularly 
in the towns of Bethel, Stockbridge, Barnard, and Roy- 
alton, also in Woodstock, Randolph, and adjacent towns. 

It had been in the neighbouring states for a year or 
two, and in the southern part of Vermont. It now 
spread through the middle and north parts of the state, 
I believe very generally, and continued through the next 
year ; prevailing most in the cold season of the year. 
Dysentery and common fevers prevailed mostly in the 
warm season of the year. 

1796. 

The first winter months of this year were the season 

of the greatest prevalence of the ulcerous sore throat, or 

canker rash. It attacked, with great force, children and 

young people. Some aged people had it, who said they 

6 



*2 HISTORY OF DISEASES. CHAP. II. 

had been affected with it in their younger years. The 
eruption was, for the most part, very red, sometimes 
more of a crimson appearance ; some cases had no ves- 
tige of eruption. Some had great swelling in the throat 
externally as well as internally. The fatal cases termi- 
nated, sometimes on the third, more commonly on the 
fifth or seventh day, with great distress, delirium, and 
difficult respiration. 

No data can be procured, in this part of the country, 
to ascertain the number of deaths in each town ; if any 
thing is offered, it must be a matter of opinion. I should 
say then, that in towns containing 150 families, perhaps 
20 or 25 died. Some towns had more fatal cases than 
others in proportion to their population. During this 
and the following year, it affected perhaps all the towns 
in the middle and northern parts of the state. 

It is said this disease invaded Boston in 1795, but I do 
not learn the month. It seems, this disease had a pro- 
gression from south to north. It was in the city of 
New York in May, 1793 ; and in England about the 
same time, and continued there for several years with 
different degrees of violence. Webster. 

The pulmonic fever of the winter of 1812-13, evidently 
began in the north, on lake Champlain and in Canada. 
It was destroying the soldiers at Burlington, about a 
month before it appeared at Woodstock and its vicinity. 
It was not until the following winter, that it appeared 
in any considerable degree in Connecticut, the middle, 
and some of the southern states. Perhaps these facts 
may be of much future utility.* 

* Since writing the above, an account is noticed in the 
National Intelligencer, from Ersalls Martin, (perhaps of 



CHAP. II. HISTORY OF DISEASES. 4S 

The measles appeared in the spring of this year. 
Many cases were very severe. In the summer of this 
year, the common fevers of the season seemed to as- 
sume a more formidable appearance. 

In the latter part of summer and in the autumn 
of this year, dysentery was considerably frequent, and 
very fatal in some places. Small children were often 
destroyed by it, within twenty-four hours. The pulse 
would soon become exceedingly quick and small, and 
the patients sink and die, in some measure as in spotted 
fever. It was very fatal in a neighbourhood in Stock- 
bridge. It was very severe in different towns in the 
state. 

Doctor Gridley of Castleton observes ; " The dysente- 
ry has often been prevalent in this town and county ; I 
believe it never appeared with so alarming symptoms, as 
in the summer of 1796. It was also very distressing in 
Rutland." 

1797. 

This year, the scarlatina continued in the middle and 
northern parts of the state, more particularly in the cold 
season of the year. The summer and autumn were 
accompanied with dysentery, in several towns, in Ver- 
mont and New Hampshire. 

Fevers, which had formerly been called inflammato- 
ry, bilious, or remittant, seemed to assume a more for- 
midable aspect. They were now called by some typhus, 
by others putrid. In some instances, the patients would 

apocryphal authority,) that a disease similar to this prevailed 
at Easton in Maryland in the winter of 1812-13. " Out of 
a population of 1500 souls, 500 died." 



44t HISTORY OF DISEASES. CHAP. II. 

be affected with a yellowness of the skin, and without 
any particular affection of the region of the liver. This 
yellow colour was not so often an attendant of severe 
cases, as of the more mild. It was sometimes discovera- 
ble in persons so slightly indisposed as to be able to go 
about. 

But a small proportion, however, of those affected 
with fever had the yellow colour.. The head and sto- 
mach were most affected; often attended with deliri- 
um, and afterward with puking. The fever, although 
generally pretty severe at its commencement, had a 
strong tendency to procrastinate its period of termina- 
tion ; it was therefore called slow or typhus fever. 
This fever appeared to be of the same character with 
that, mentioned by Mr. Webster, as affecting Windsor, 
Hanover, and Royaltou the following year. Bethel is 
situated on White river, four miles west of Royalton ; 
the fever prevailed in all that vicinity, this year and 
in 1798. It did not arrive at the height of its greatest 
severity in this region, until the year 1800 ; but has 
continued every year ; and with much severity in 1803 ; 
and more or less until the present time ; affecting differ- 
ent towns with different degrees of severity. Since the 
years 1807 and 8, common typhus has been less fre- 
quent, although a pretty constant attendant. Canine 
madness prevailed this year. 

"In August 1797, appeared a comet, which accord- 
ing to calculations of astronomers, passed near the 
earth, although it was of small apparent magnitude, 
and seen by few people." Webster. 



CHAP. II. HISTORY 0¥ DISEASES. 45 

1798. 

The most prevailing diseases of this year were ty- 
phus fever, aud dysentery. They were both severe in 
some places and neighbourhoods, whilst others were 
more exempt. Typhus fever prevailed in Hanover, 
New Hampshire ; at Windsor, Royal ton, Bethel, Ran- 
dolph, &c. 

There was something of a drought in the months of 
July, August, and September, which are the principal 
dysenteric months. But dysentery as often prevails 
without drought. By letter from Dr. Ware, of Pom- 
fret, « seventeen adults died of dysentery in September 
aud October, chiefly under a course of high stimulants. 
Those who recovered were treated with alkaline and 
neutral salts." 

During the latter part of summer and autumn, of this 
year, if my information is correct, the dysentery proved 
very fatal at Norwich, on the banks of Ompompo- 
noosuck river ; about thirty died. 

In the autumn of this year, a mortal dysentery is re- 
ported to have prevailed at Farmington, in Connecti- 
cut. It is said to have been caused by miasmata from 
stagnant water, or the overflowing of the meadows by a 
previous freshet. It cannot be said that the local cause 
did not originate from this. But what should cause the 
same disease in Pomfret, situated upon fair high ground, 
with not one fourth of an acre of meadow or sunken land 
in the town ? What should cause it upon the dry and 
pleasant banks of the Ompomponoosuck in Norwich ? or 
the dry upland in the east of Hanover ? or on the heights 



46 HISTORY OF DISEASES. CHAP. II. 

of Bennington, or the hills of Randolph, Stockbridge, 
and a variety of similar situations, in the eastern part of 
Vermont, whilst many other situations of low land were 
exempt ? It may have a local cause which co-operates 
with the general pestilential condition of the atmos- 
phere ; but physicians must use more vigilance and 
exertion, before the particular conjunct cause can be 
identified; more observations must be made; and they 
must be divested of the old false theories, that have 
been so long used to no good purpose. When the gene- 
ral pestilential influence is present, perhaps very slight 
local causes may give it energy, and these may be such 
as have hardly been thought of. When epidemic dis- 
eases are once excited in a neighbourhood, are they pro- 
pagated, in part, by a sort of sympathetic association 
of which the subject is unconscious ? 

Typhus prevailed at Arlington ; one death in twenty- 
five cases. It began in July, and continued till Novem- 
ber. 

The dysentery, this season, began in Sandgate and 
Salem, the latter part of July. It was very mortal in 
that region this year, as well as in other places. About 
fifty died in those places. Dysentery was very severe 
this year, in September and October in Bethel, especial- 
ly in a particular neighbourhood. I believe ten or twelve 
died in this neighbourhood after a short term of sick- 
ness. About eighty had it in the town. 

1799. 
Typhus fever and dysentery were very prevalent, 
this year, in different places. Typhus fever began to be 



CHAP. II. HISTORY OF DISEASES. 47 

pretty common at Woodstock, in many cases alternating 
with dysentery. 

Continued or typhus fever prevailed with much seve- 
rity in Bethel, Royalton, &e. The disease commonly 
yielded to the depleting and diaphoretic method of cure, 
diligently persisted in. 

Many towns in the western section of the state, were 
afflicted with dysentery ; also in the eastern part, but 
not with the severity of last year. 

It may be remarked, that although dysentery prevails 
usually in August and September, it is not confined to 
these months, neither to the warm season. This year 
dysentery prevailed in Bethel, in March and April. 
About fifty cases occurred, principally in one quarter of 
the town. The symptoms were as distinctly marked as 
in any dysenteries I ever witnessed. Neither could I 
discover any peculiar state of the system different from 
the autumnal dysenteries. The disease was very obsti- 
nate, but not attended with the fatality of some dysen- 
teric periods. 

1800. 
The summer of 1800, seems to be the period of the 
greatest severity of typhus fever in this vicinity, parti- 
cularly at Woodstock, where I then lived. It prevailed 
with its greatest force in July, August, and September ; 
but was frequent in the beginning of winter. It showed 
a strong tendency to affect the stomach and bowels, by 
producing severe puking, and also in producing intesti- 
nal discharges of blood,- oftentimes to a great amount 
in a short period of time. It also had a strong tendency 



£8 HISTORY OF DISEASES. CHAP. II. 

to continue a great length of time. In some cases, treat- 
ed improperly, or neglected, it would terminate fatally, 
in about a fortnight. Others of a slighter degree of 
violence, under like management, would terminate fatal- 
ly, perhaps in twenty, thirty, or forty days ; whilst some 
might recover after an hundred days, being mere skele- 
tons. 

In some eases, the access of the fever would be consi- 
derably violent; in others, and more commonly, the 
fever would be four or five days in forming. 

Dysentery and cholera morbus frequently appeared 
in summer, and pleurisy and croup in winter. 

" In the summer of 1800, dysentery appeared in the 
east part of Hanover, and in several adjacent towns, and 
carried off many children and some adults, to the num- 
ber of between seventy and eighty. In the former year, 
when Hanover was visited with the dysentery, it was 
confined to the College-plain, so called, and between 
twenty and thirty died of it. In the last mentioned sea- 
son it did not attack any on the College-plain. The 
same year it prevailed in several towns in Vermont." 
Letter from Prof, JV\ Smith. 

1801. 

The most prevalent diseases of this year were the 
same as those of several years past. The fever, called 
typhus, prevailed more or less in different places : also 
some dysenteries. 

Intermitting and remitting fevers are very common 
in the western part of the state, adjoining lake Cham- 
plain. They extend but a little way from the lake, un- 



CHAP. II. HISTORY OP DISEASES. 49 

loss in the vicinity of low and wot land. They are not 
so common as in former years, soon after the clearing of 
the land. They are not met with in the eastern section 
of Ihe state, unless some solitary cases contracted by 
travelling in the neighbourhood of the lake. 

It has frequently happened, that people from the eas- 
tern part of the state, residing only a short time in the 
vicinity of the lake, in the summer season, would expe- 
rience the disease ; and after appearing to be perfectly 
free from it through the winter, perhaps for six months, 
and residing all the time in the eastern part, would have 
another attack in the spring. These second attacks 
were often very obstinate. 

Calculi of the urinary passages is a very rare disease 
in this state. A peculiar chronic inflammation or irri- 
tation in the neck of the bladder is more common, 
and has often been taken for calculi, by experienced 
men upon a slight examination. 

1802. 
Dysenteries very generally prevailed the summer and 
autumn of this year. They did not seem to be confined 
so strictly to particular neighbourhoods, as on some for- 
mer occasions, but were heard of in almost all directions. 
Dysentery was very mortal at Greenfield, in Massachu- 
setts. I believe about fifty died in one part of the town. 
It prevailed, this season, very extensively in the state of 
Connecticut. I am not in possession of any proof how 
far this disease extended this season, but believe it was 
pretty general in the New England states. 

7 



50 HISTORY OF DISEASES. CHAP. II. 

It is not expedient to enter into any discussion in this 
place, on the treatment of this disease. It may, how- 
ever, be observed, that it is a general disease of the sys- 
tem, as much as any epidemic that affects the people of 
this country. It has a locality ; so has every other epi- 
demic. So long as the treatment is directed principally 
to the local affection in the intestines, little benefit can be 
gained. If it is treated by general remedies to remove 
the violence of fever, and general diseased action, the 
local affection will subside of course in due time. 

I am informed that the malignant sore throat prevail- 
ed in Cornish and Claremont, N. H. in the spring of this 
year ; about thirty had it, and several died. The mea- 
sles spread pretty extensively this winter and spring. 

Pertussis, or hooping cough, prevailed this year. 
" The hooping cough and measles were frequent in 
Pomfret in August and September. A dysentery fol- 
lowed the measles, which proved fatal to most of the 
children, under the age of three years, who were affected 
with it. Alkaline absorbents were the best remedies." 
Bi\ Ware, 

In the winter of this year, many cases of cynanche 
trachealis or croup were met with. 

1803. 
As steadily as the seasons of the year return, have 
typhus, or mixed fevers, and dysenteries, returned for 
several years in succession. Their obstinacy, and per- 
haps their frequency, this year, has hardly been surpas- 
sed in either of the years during this pestilential period. 
These diseases did not appear so frequent and numerous 



CHAP. II. HISTORY OF DISEASES. $1 

at Woodstock, as in some former seasons ; but, in many 
towns not far distant, they were very severe. Both 
these diseases, as also the scarlatina, were very preva- 
lent in Hartland, especially in that part adjacent to Con- 
necticut river. The fever and dysentery prevailed in 
the same neighbourhood at the same time. In the same 
patient, it would sometimes be fever, and sometimes 
dysentery. 

The diseases of this season were very extensive ; but 
few towns escaped unusual sickness in the summer sea- 
son, whilst but little sickness prevailed in the winter. 

In 1802 and 1803, the canker raslu or throat distem- 
per, prevailed very generally in Vermont and New 
Hampshire. It was not so general as that of 1795 — 6 
and 7 ; and I believe not quite so mortal. Since about 
the year 1803 or 1804, it has not prevailed in this part 
of the country. 

According to a letter from Dr.Littlefield, of Arlington, 
this disease prevailed there and in Sandgate, Salem, &c. 
about this period, or rather more particularly in 1803. 
He says, " anasarca has occurred very frequently, al- 
most in every severe case." Our reflections on this 
will be found under that article. 

Dysentery, says a correspondent, was very distressing 
in Hubbardstown ; but I have no particulars. 

Hooping cough prevailed very considerably this 
year, particularly in the latter part of summer and au- 
tumn. It proved fatal in some instances. 



52 HISTORY OF DISEASES. CHAP. II. 

1804. 

The diseases of this year were less remarkable than 
during several of the preceding years. Fevers and 
dysenteries in summer, and pleurisies and quinsies in 
winter, were considerably frequent. 

In autumn the typhus fever was epidemic in several 
towns in the west part of the state. 

Dr. Bowen observes, that the canker rash prevailed 
in Reading in 1803 and 4. In 1803, it assumed the in- 
flammatory type. Out of about two hundred cases, 
treated as an inflammatory complaint, ten only proved 
fatal. In 1804, he thinks, it assumed the malignant 
type. Fifteen died out of forty eases. In 1803, his 
common practice was blood-letting, neutral salts, &c. 
In 1804, he thinks blood-letting was injurious after the 
first 24 hours. Warm bath and small bleeding were 
useful, if practised early. He further observes, « In 
the fatal cases death happened from a translation of 
inflammation, and effusion in the brain, as appeared on 
dissection." 

In September, an influenza or slight catarrhal fever 
appeared ; it was general on the west side of the state, 
but my recollection of it is imperfect. This season, 
dysentery prevailed with great severity in Castleton. 
About this time, says my correspondent, it swept away- 
vast numbers in Orwell and Shoreham. 

Pulmonary consumptions are prevalent, more or less 
every year. 



CHAP. II. HISTORY OF DISEASES. 55 

1805. 

We continue to be associated with our former compa- 
nions, as closely as misfortunes tread upon the heels of 
disobedience. Some dysenteries, but principally typhus 
fever. I have thought the fevers of this autumn and 
winter not inferior to any we ever had in this vicinity, in 
their obstinacy. They were not so frequent in those 
neighbourhoods that had been formerly afflicted ; but in 
some others they were very severe. In one neighbour- 
hood in the north part of Hartford, typhus was very 
severe ; it continued through the months of September, 
October, &c. to February. About one in ten died. 

In the spring of this year, several instances of canine 
madness occurred. 

1806. 

Dr. Bowen further observes : for fifteen years past we 
have had some cases of dysentery every year ; in 1800, 
1802, and 1806, it prevailed generally. In 1806 and 
every year since, he observes, I have found it a different 
complaint from what our authors have generally de- 
scribed it to be. He considers it to be attended with 
fever, and an inflammation of the inner coat of the whole 
intestinal canal, with effusion of blood, mucus, &c. " In 
more than three hundred cases within eight years, not a 
solitary instance has occurred where scybala were dis- 
covered." 

Since the year 1806, dysenteries have been less fre- 
quent and less fatal, than for seven years previous. 
Some late seasons have passed with but few cases. 



5* HISTOBY OF DISEASES. CHAP. II. 

1807. 

A very extensive and severe influenza prevailed this 
year, all over the United States and Canada. It likewise 
appeared in Europe. It seemed to have a moderate 
progression. It has been supposed by some that it be- 
gan at some certain place, as for example, at the city of 
New York, and spread in different directions, but this is 
doubted. Information might not have been correct on 
this point. The liberty will be taken to suggest a mis- 
take in the Medical Repository for 1808, on this subject, 
where it is represented as appearing much later in the 
northern states, than in the city of New York. The 
supreme court of this state commenced its session at 
"Woodstock on the 18th of August. The trial of two 
prisoners indicted for murder, drew a great concourse 
of people together. The disease was almost universal 
in this and the second week of the court, affecting a 
great proportion of the attendants. It was noticed a 
few days before the sitting of the court. It appears 
from the statement alluded to above, that this was very 
near the time it appeared in the city. It prevailed very 
generally about this region at the same time ; but in 
particular places, its attack was a little later. 

It proved rather severe in many places. The severity 
of pain in the head or side required blood-letting, mode- 
rate sweating, cathartics, &c. to remove it. 

Besides influenza, some places were afflicted with 
fevers, which some called bilious, others typhus. At 
Randolph, Brookfield, and Brantree, fevers prevailed 
with considerable mortality. 



•HAP. II. HISTORY OF DISEASES. 55 

A correspondent remarks, that typhus was more ex- 
tensive and mortal in the west part of the state in 1807, 
than at any other period. 

About the 20th of September, a small comet appeared 
in the western part of the heavens. It was visible only 
for a few weeks. 

1808. 

Fevers began this season in the month of July, conti- 
nued through August, September, and October. A great 
many were affected, and the disease proved mortal in 
many instances. It was particularly so in the family of 
Jacob Smith, Esq. of Royalton ; his wife and two others 
of his family died with it. About thirty cases occurred 
in the village of Woodstock under my attendance ; 1 be- 
lieve not a fatal case happened at this time. They were 
generally treated early with frequent and full bleedings ; 
often three times in as many days,; with frequent eme- 
tics and cathartics, blistering, sweating, &c. By these 
remedies, apportioned to the violence of the symptoms, 
the disease was arrested, and almost every case restrict- 
ed to one or two weeks, that was treated in a similar 
manner; whilst others that were treated by opposite 
measures, were sick the usual time. 

I was attacked with it myself, in the latter part of 
July ; but the above measures, so far averted the dis- 
ease, as not to confine me strictly one day. With 
much exertion I was able to attend upon others. 
Again in August, another attack was averted by similar 
measures ; and again in the fore part of September, a 



56 HISTORY OF DISEASES. CHAP. II. 

third attack, after fatigue and exposure, confined me 
four weeks with a serious disease. 

The diseases of the winter following, were nothing 
remarkable ; it might be said to be healthy. 

1809. 

It appears from a communication from the Rev. Ebe- 
nezer Fitch, president of Williams' college, to Dr. North, 
that the average heat of this summer was two degrees 
below the average heat of seven successive summers, 
ending in 1810 ; and that the average heat of 1810 was 
one degree below the average heat ; and consequently 
these two summers were considerably colder than usual. 
This was undoubtedly the fact. The summers of these 
two years were so cold, that corn did not ripen as usual, 
in this latitude. 

I would suggest, that diseases are not much influ- 
enced by the sensible qualities of the atmosphere, any 
further than they act as exciting causes. If the gene- 
ral pestilential state of the atmosphere be absent, a few 
degrees of difference in heat or cold, make no sensible 
variation in the quantity of sickness. The summer of 
1805, averaged five degrees of heat above 1809, yet 
we do not find either of these summers attended with 
any more, nor indeed hardly so much sickness general- 
ly, as other summers. The like may be said of sum- 
mer and winter. 

With respect to the coldness of summers, it will be 
suggested, that the great planetary influences which 
alter the attractions of minor planets, not only produce 
a variation in the quantity of heat and cold, but also 



< IIA1\ II. HISTORY OF DISEASES. 57 

effect a change of elementary principles, so far as to 
predispose (he bodies of men to commotion and disease. 
In this view coldness and sickness would both be separate 
effects of the general cause. The greatest quantity of 
•sickness in New England was in 1811 — .12 and 13. 

Spotted fever prevailed this year very considerably in 
the state of Connecticut. The year was not remarkable 
for any severe epidemic in this state. The common rou- 
tine of sickness continues. A blast on wheat. 

Previous to this year, the greatest proportion of sick- 
ness from epidemic diseases had occurred in the summer 
and autumnal months, very constantly. Since this time 
the proportion has been reversed; and perhaps two- 
thirds of the sickness has happened in the winter sea- 
son of different years to 1815. Sickness from epidemic 
diseases is here alluded to particularly. This is a proli- 
fic subject for speculation, and merits investigation. 

1810. 

No extraordinary circumstances attended diseases this 
winter, in the vicinity of Woodstock. But that pestilen- 
tial influences existed in the common atmosphere, is in- 
ferred from the prevalence of different diseases in other 
places. 

The spotted fever prevailed this year in other places, 
more than it had done any year since its first appearance, 
particularly in Massachusetts. As it may be interesting 
to mauy to know the progress of the spotted fever in 
other places, the following extract is inserted from the 
'Repertory, taken from a letter from a gentleman in Pc- 

8 



38 1IIST0RY OF DISEASES. CHAP. II, 

tershani, dated March 19, 1810. " The distress of this 
part of the country is beyond any thing you can conceive. 
Seven men and women, and one child, were buried in 
Barre this afternoon. Sixty are now sick. Dr. Holmes 
told me this day that twenty physicians would not be too 
many for that town alone, and the disorder had made its 
appearance in Athol." 

Considerable sickness prevailed in the western part of 
the state of Vermont. In a communication from Dr. 
Gridley, of Castleton, it is stated, « During the winter 
of 1S09 — 10 the typhus fever entirely subsided in the 
county of Rutland. Almost every disease of the winter 
and spring appeared to be of the sthenic class. Pulmo- 
nic inflammation was frequent and formidable. Blood- 
letting in the most copious manner, and repeated with a 
bold hand, became necessary to save the sick from death. 
Many children were affected with the cijnanche trachealis 
or rattles. Former remedies availed but little. I re- 
solved the whole difficulty into a phlogistic diathesis of 
the system. I drew blGod repeatedly from young chil- 
dren, often from the jugular veins." 

" One patient, who had apparently a moderate attack 
of pneumonia, was bled once and took a cathartic. The 
disease changed to the bowels, resembling enteritis. On 
the 8th day of his illness, I drew about three quarts of 
blood at two bleedings, which relieved him. About 2i 
hours after he sent for me in haste, and said he must be 
bled again. He now lost 2* ounces of sizy blood, which 
again relieved. The bowels now became pervious, and 
the patient recovered.'' 



C n IP. II. HISTORY OF DISEASES. 59 

" Dr. Safford assured me, that during more than 
twenty years practice, he never found it so necessary to 
use the lancet, as during this winter and spring. The 
sthenic diseases abated at the return of summer's heat. 
In the autumn of 1810, and the following winter, ty- 
phus fever again appeared. In the autumn of 1811, 
diseases of the inflammatory type became frequent.'' 

After this some cases of dissection are mentioned of 
those who died of croup and enteritis. Some that had 
been treated by quacks for worms. All showed the 
highest degree of inflammation. 

For the like purpose of showing, that the diseases of 
this winter were of the inflammatory or sthenic kind, 
the liberty will be taken to copy a letter in Dr. North's 
publication, from Dr. Powell, of Burlington. 

" Since the above was written, I have received a letter 
from Truman Powell, M. B. dated Burlington, (Ver- 
mont) August 8, 1810, from which the following is an 
extract. Speaking of a complaint which had raged in 
his neighbourhood, he says, * It commenced about the 
first of January, 1810, and continued to increase until 
about the first of March, when it seemed to be pretty 
much on the decline, and disappeared by the first of 
April, though in some towns further south, it prevailed 
much longer, even into June. But those towns were 
generally exempted from the disease during the win- 
ter. The symptoms of this disease were those com- 
mon to all other pneumonic affections, differing no way 
but in the degree from a common pleurisy or peripneu- 
mony. It generally among physicians went by the name 
of malignant pleurisy, or peripneumony, which seemed 



60 HISTORY OF DISEASE-. CHAP. II. 

to be an appropriate term. It predominated over all 
other diseases ; no person could fall sick without 
having some pain in the breast, side, or shoulder, with 
cough and expectoration of a very ill conditioned mat- 
ter, resembling what is generally discharged from 
sores in a state of gangrene; no precursory symptoms 
were to be observed, whereby the approach of the dis- 
ease could be known. The seizures were almost instan- 
taneous. Many would get up in the morning and eat a 
hearty breakfast, and, in thirty minutes, be in the most 
excruciating pain. It generally finished its course in six 
or eight days, terminating either in death or a favoura- 
ble crisis. A few instances occurred where the weight 
of the inflammation fell upon the throat, in which case it 
produced a complete angina maligna. A few other cases 
occurred where the face and limbs were much tumefied 
and inflamed, in all of which cases the lungs seemed ex- 
empted from inflammation. I have been informed by a 
respectable physician, who lives at the northward, that, 
in his vicinity he had a number of cases of spotted fever 
with the disease above named ; but one or two happened 
in this vicinity. Yet I have no doubt that the spotted 
fever and the disease above named originate from one 
and the same cause, differing no way but in degree and 
seat of the urgent symptoms. I believe it will be ac- 
knowledged by every medical gentleman, that two epi- 
demics diametrically opposite in their natures can never 
exist at the same time in the same climate (diseases of 
specific contagion excepted :) therefore, I conclude, that 
the malignant pleurisy, which existed in this country 
last winter, and the spotted fever, which prevailed in 



CHAP. 11. HISTORY OF DISEASES. 61 

sundry parts of New England, have one and the same 
cause, differing only in degree and seat of the urgent 
symptoms." 

The identity of the hurtful principle will not be doubt- 
ed. It will be conceded, that what constitutes the diffe- 
rence between pneumonia, eynanchc trachealis, phrenitis, 
enteritis, and that peculiar disease called spotted fever, 
consists in a difference of severity and of local affection, 
in the part upon which the principal force of the disease 
may fall. Symptoms are different not only from an af- 
fection of different organs, but the identical part of the 
organ affected. For example ; when the bronchial mem- 
brane of the lungs is affected, the symptoms are not the 
same, as when the investing membrane of the lungs is 
affected, &c. 

But the foregoing facts were introduced, principally, 
to show, that the prevailing diseases of this winter were 
sthenic or inflammatory ; and this accords with my oavii 
observation. Although sickness was not great in this 
vicinity, a very considerable number of cases occurred, 
and they were treated very successfully by bleeding and 
antiphlogistic remedies. It will be suggested, that those 
diseases of the winter season, such as pneumonia, spotted 
fever, &c. are liable to impose, in a great measure, upon 
the judgment of the observer. The symptoms of torpor, 
or inaction, only denote a higher grade of diseased im- 
pression : remove this imposing restraint to the ordinary 
grade of action, so that the functions of the system can 
respond, and high action called sthenic, will become ap- 
parent, and the patient in the wav of a cure- The word 



62 HISTORY OF DISEASES. CHAP. II. 

malignant denotes a higher grade of impression ; so far 
oftentimes, that the functions are impaired suddenly and 
totally. A person may be said sometimes to die of 
debility, or some asthenic disease with all the symp- 
toms of apoplexy, and with such a pressure in the vessels 
that a purple colour is manifest on the surface, and per- 
haps blood issuing from the lungs or some other part. 
This does not seem correct. 

Although a patient, in this condition, may receive some 
small inconvenience from the great contrast he may ex- 
perience, for the time present, by the loss of some blood 
and other evacuations, yet it is the only way to a suc- 
cessful termination. After the faintness from sudden 
subduction passes off, the action of the system emerges 
into inflammatory or sthenic action ; but more hereafter. 

Is it possible to conceive that the diseases here, and 
those a little distant, as in Connecticut, and the north 
part of Massachusetts, should be directly opposite, in 
like habits, and in the same season of the year ? Is it not 
more improbable, that in the same neighbourhood, and at 
the same time, two diseases should prevail, and perhaps 
in the same family, of direct opposite diatheses, requir- 
ing opposite treatment ? — It is a common observation, and 
I think pretty just, that for two or three years before 
the spotted fever appeared here, common diseases and 
slight indispositions were attended with more cutaneous 
eruptions or slight erysipelatous affections of the skin 
than formerly. 

At Sandgate typhus fever was prevalent from July to 
March; sixtv cases and six deaths. 



CHAP. II. HISTORY OF DISEASES. 65 

A succession of rainy weather this year in July and 
August, which occasioned a flood, and did considerable 
damage; it was not, however, so great as the one which 
happened the year following. 

1S11. 

The disease, called spotted fever, made its first appear- 
ance in this town and vicinity this year, in the month of 
January. As many put much reliance on the sensible 
qualities of the air and vicissitudes of the weather caus- 
ing diseases of our climate, I have thought best to insert 
a short abstract of the weather made by myself at the 
time. 

This disease appeared in a decided form about the 23d 
of January, although some cases happened a few weeks 
previous, showing a petechial character. At this time 
the earth was fixed in frost with steady, moderate, cold 
weather, and a fine serene air. The weather continued 
unusually pleasant for the season, and without rain, un- 
til the 22d of March ; then but little, and on the 23d, in 
the evening, considerable rain fell, with thunder and 
lightning. 

A few days after the 23d of January, snow fell mode- 
rately, so as to make good sleighing, which on the 23d 
was but just sufficient to cover the ground, together with 
some ice. At various times, snow fell in the fore part of 
February, so that the whole was nearly two feet deep. 

The snow storms were moderate, and with little wind. 
About the 26th of February, the snow began to melt by 
the moderate warmth of the air, and mild rays of the 



64 HISTORY OP DISEASES. CHAP. II. 

sun. This state of the air, for the most part, continued 
with unusual pleasantness, and moderate south breezes, 
until the 21st of March, when the snow was gone, except 
in the woods, &c. 

The preceding autumn was remarkably pleasant. But 
little rain fell after the high flood, the latter part of 
July; enough, however, to prevent a drought. The frost 
so far left the ground, that I saw people ploughing green 
sward on the 28th of March ; a rare occurrence in this 
place. 

Nothing remarkable occurred in the weather through 
the spring months. The snow was gone earlier than 
common, and the month of April was rather milder than 
usual. The spotted fever continued very severe through 
this month. 

For about two months the greatest proportion of cases 
were confined to the village where it began ; after about 
the 20th of March, the greatest proportion were in the 
more distant neighbourhoods. The adjoining towns suf- 
fered most severely the following year. 

The number of new cases were about the same each 
week until about the 23d of March ; perhaps thirty-five 
each week, in the neighbourhood and vicinity. As no 
correct account was kept, and as this village is situated 
near the corner of several towns, no exact limits are set. 

The week previous to the 23d was attended with the 
greatest number of deaths. The disease, instead of be- 
ing ameliorated by the benign influence of the weather, 
seems, like the spotted adder, to gain new vigour from 
the ravs of the sun. 



* HAP. II. HISTORY OF DISEASES. 65 

I have no means of giving the number of cases, only as 
a matter of opinion. Perhaps there might be five hundred 
and fifty, or six hundred, reckoning five miles each way 
from the court house. The number of deaths by this 
disease in five months, was between sixty and sixty-five 
in the above limits. About eight of this number died 
before medical assistance could be procured. See fur- 
ther the history of the disease in Chap. vi. 

The disease, in the course of the winter, appeared in 
a great proportion of the towns in the state, particularly 
in the eastern part extending to the line of Canada, and 
even very considerably into that province. From infor- 
mation, which I believe to be correct, from twenty to 
thirty perished in most of the towns in that region. 
In the town of Barnet, as published in the newspapers of 
the 1st of March, out of thirty cases, nineteen proved 
fatal, and the disease was still raging. The deaths were 
generally sudden, and caused great alarm and consterna- 
tion among the people. 

Tiie disease was severe in Randolph, Barre, and vici- 
nity. Many fatal cases occurred in that region, but I 
am not favoured with any statement from physicians 
in that quarter. Many cattle are said to have died in 
this region about this time. I have been credibly in- 
formed, that the spotted fever prevailed in the new set- 
tlements of Lower Canada, in the summer of this year, 
and the following spring; and also, that blood-letting 
was very useful. 

9 



66 HISTORY OF DISEASES. CHAP. II. 

The attacks and progress of this disease were gene- 
rally sudden. Children sometimes went to school appa- 
rently in perfect health, who would return home distres- 
sed, and, in some instances, be corpses in three or four 
hours. More often, they would awake in the morning 
in a comatose and distressed state, with a very quick 
pulse, and die in a few hours. It was not confined to 
children. Many cases occurred in men and women, pos- 
sessing every appearance of the most firm and athletie 
habits, being prostrated before it in a few days, and some- 
times in a few hours, with apparent symptoms of debility 
or asthenia. They would often be incapable of describ- 
ing their feelings, from an imbecility or aberration of 
intellect, and commonly expire in a comatose state. 

Dr. Ware mentions, that in Pomfret, this year a num- 
ber of foxes were found dead : and that some were kil- 
led at mid-day by children, near dwelling houses, to the 
amount of about a dozen. What their disease was he 
could not determine. Also squirrels, about this time, 
were seldom seen, and are not yet so plenty, as before. 
They were supposed to be destroyed by pestilence. Dis- 
ease appeared also among sheep and geese. 

Spotted fever appeared in Reading, the latter part of 
February : about 35 cases : only 10 or L2 severe ; three 
deaths. In December, 20 cases,, five deaths. 

Dr. Huntington observes, that the spotted fever ap- 
peared at Greensborough the 19th of March. He had 
73 cases in that town and in Hardwick, and not one prov- 
ed fatal. He bled from one to five times, sweated, gave 
also Vol. Tinct. Gum Guaiac. Ether, &c. He places 



CHIP. II. HISTORY OF DISEASES. 67 

do reliance on pukes and purges, at this time and place. 
In other places he used them, but the result is not given. 

It is a common observation, and I believe just, that 
the greatest number of severe and fatal eases of spotted 
lever, occurred in families most destitute of the common 
necessaries and comforts of life. Although many cases 
happened under circumstances the reverse of this, yet 
the cases could, for the most part, be referred to some 
unusual fatigue, or particular exposure. In families 
more destitute, not only the liability to have the disease 
excited, is greater, but also, when attacked, the means 
necessary for opposing its rapid and fatal tendency, are 
not usually at hand; neither are they applied with that 
solicitude and attention, which is characteristick of the 
more provident. Although a high state of stimulation 
is unfavourable to security from morbid impression, yet 
a low and torpid action, from scantiness of regular and 
warm diet, warm covering, &c. invites disease, especially 
in cold seasons. 

" In the summer and autumn of this year, the dysente- 
ry raged with great mortality in Whitehall and Hampton, 
in New York. The attacks were severe, and the pro- 
gress so rapid in young children, that almost every 
remedy proved useless. Soon after the disease appeared 
formidable at Whitehall, a great freshet spread desola- 
tion through Clarendon, Rutland, Middletown, Paultuey, 
Castleton, and Fairhaven. The water was raised to an 
unusual height in lake Champlain ; the low land in 
Whitehall was overflowed by the water of the lake, in a 



68 HISTORY OF DISEASES. CHAP. II. 

manner unknown to the oldest inhabitants. This extra- 
ordinary phenomenon occurred on the 2 2d and 23d of 
July. The dysentery raged soon afterwards with great 
mortality. The period, in which dysentery has proved 
most distressing, has been from the first of July to the 
first of November. This is the period in which bilious 
fevers have uniformly prevailed in the vicinity of our 
stagnant waters." Letter from Dr. Gridley, of Castle- 
ton. 

It appears from the above, that dysentery had begun 
before the freshet. How far this aggravated the dis- 
ease, may be difficult to determine. I have not learnt 
that the places most inundated by the water, have been 
more sickly than others. The spotted fever raged the 
winter preceding and following. See further hints on the 
flood in Chap. in. s. 3d. 

Our correspondent remarks, "in the autumn of 1811, 
diseases of the inflammatory type became frequent." 
At the same time, a considerable number of cases oc- 
curred in the vicinity of Woodstock, from the fashion of 
the day, called typhus ; but which had considerable of 
inflammatory diathesis, although their period of termina- 
tion was inclined to be protracted. Also some cases of 
severe dysentery. 

In the months of September and October, appeared a 
very brilliant comet. 

1812. 

The spotted fever prevailed the winter of this year in 
Pomfret more than it did in 1811. It was very severe 



CHAP. II. HISTORY OF DISEASES. 69 

in many cases. By report of Dr. Ware, 52 persons died 
of it this, and the preceding year. Some of these cases 
proved fatal before medical assistance could be procured. 

More severe cases occurred in the -south parish in 
Woodstock in some neighbourhoods, this winter, than 
the winter before ; but the whole number of cases in the 
town, was not perhaps one to seven, that occurred the 
year before. In Reading 60 cases, nine fatal ; mostly in 
thirty hours after the attack. In Plymouth, 30 cases, 
and four deaths. 

In Arlington, on the Battenkiln river, and in Po^nal, 
typhus fever prevailed. About one fatal case in every 
ten. This species of disease, which ought to be consi- 
dered a mild continued fever, prevailed more or less 
during the period of spotted fever. It was common for 
a severe attack of the latter to terminate in typhus or 
continued fever of various duration. 

The measles prevailed the summer and autumn of this 
year, principally in the western and northern parts of 
the state. Many of the soldiers of general Dearborn's 
army were affected with the measles on their return 
from the borders of Canada to Platsburg and Burling- 
ton, but a short time before the appearance of the severe 
pneumonic fever to be mentioned the followiug year. 
The measles had not left the army when the pneumonic 
fever began. 

1813, 
The autumn of 1812, and winter of 1813, ushered in 
the most severe epidemic disease, that has ever afflicted 
the inhabitants of Vermont, the epidemic peripneumo- 



70 HISTORY OF DISEASES. CHAP. II. 

ny, or disease of the lungs. It seemed to have the fea- 
tures of the disease, that had been in the state for about 
two years, called spotted fever ; the chief difference seem- 
ed to be, that now the greatest foree of local affection fell 
upon the lungs. What elementary changes should pro- 
duce an aptitude in the pestilential influence to affect, 
in a special manner, the lungs, must be left for specula- 
tive philosophers to suggest. The unity of the hurtful 
principle is chiefly inferred, from many places being 
affected with this disease, in some measure, a year or 
two before, whilst spotted fever more commonly prevail- 
ed; from spotted fever's occurring at the same time 
with this in many places ; and from the common fea- 
tures, and sudden fatality of both diseases. See more 
of this in Chap. vii. 

The disease appeared at the northward before it did 
in the county of Windsor, perhaps about one month. It 
appeared amongst the soldiers at Burlington, some weeks 
before it did amongst the inhabitants of that place. 
Very near the time it appeared at Burlington among the 
soldiers, it appeared also among the soldiers at Plats- 
burg and Sacketts Harbour, and also in the camp at 
Greenbush, opposite Albany. No satisfactory account 
has ever been given the publick relative to the ravages 
of this disease at Burlington. I have solicited informa- 
tion from resident physicians there ; but have received 
none. By information from some of the most respecta- 
ble inhabitants of that place, and also from others resid- 
ing there at that time, I am warranted in stating, that 
for some time, it was common for eight or twelve to die 



i HAP. II. HISTORY OP DISEASES. 71 

in a day. The whole number is said to be not less than 
seven or eight hundred in four months. Several dead 
bodies were carried through this place in sleighs, to be 
interred among their friends. The number of soldiers 
stationed at this encampment was about twenty-five or 
twenty-eight hundred. 

Perhaps the fatigue and exposure of a camp life to 
men not accustomed to it, might have a share in ren- 
dering the soldiers the first victims of the disease. The 
depression of mind from a repulse immediately before 
under general Dearborn, in an attempt to invade Canada, 
may also be noticed. 

The disease was not, however, confined to the camps. 
As the pestilential state of the atmosphere progressed to 
a degree of greater violence, the disease appeared among 
the inhabitants in the most comfortable condition ; first 
in the northern section of the state, and immediately 
after in the middle, and southern sections. It is said to 
be about three weeks after it was very severe among 
the soldiers at Burlington, before the inhabitants were 
much affected. It, at length, became distressing and 
yery mortal among the citizens of that place ; and in 
about one month from its first appearance, it was pretty 
general over this and the adjoining states. The pes- 
tilential diathesis of the atmosphere, was not at its 
zenith until the first week in March. In this month, it 
raged with its greatest severity. 

It is said, that many of the soldiers died in four or 
eight hours after the attack, and a few in two hours. 
It was fatal also in some places among the citizens, 



7% HISTORY OF DISEASES. CHAP. II. 

nearly in as short time. The common fatal period was 
about the fourth or fifth day. The symptoms of the 
disease are in short described in Chap. vn. 

On account of the want of any regular returns of 
deaths in the towns in this state, it is impossible to as- 
certain the number that died of this disease. 

From pretty satisfactory accounts from the Rey. Mr. 
Chapiu, minister of the north parish in Woodstock, the 
number of deaths in both parishes by this disease the 
present year, were about fifty-four, in about five months. 
Whole number of deaths for the year, seventy-four. The 
town contains about 350 families, and the enumeration 
in 1810, was %,§!% souls. Five physicians. 

By the statement of Dr. Ware, of Pomfret, it appears 
that " In December last, the lung fever began, and con- 
tinued until about the middle of May, 1813. Forty-four 
adults died with it in that time." The correctness of 
Dr. Ware will serve as a specimen for other towns,, 
where the neglect of physicians has deprived us of any 
statement of this disease. He further observes, « where 
the practice of bleediag, puking, and purging was pursu- 
ed, free expectoration promoted, and kept up, and heat- 
ing stimulating means carefully avoided, the patients 
generally recovered." 

Dr. Page, of Sharon, states, that about forty persons 
had the pulmonic fever in that town, and that five died. 
Dr. Littlefield states, that the epidemic began at Ar- 
lington about the middle of January, and disappeared 
about the first of June. " It was not so fatal in this, 
and some of the adjacent towns, as in some other parts 



CHAP. II. HISTORY OF DISEASES. 73 

of (lie state. In Arlington, 10 deaths ; in Sandgate, 
20 ; in Sunderland, 1. From the best information, and 
some personal knowledge, I should say, in Manchester, 
60 or 70 ; in Dorset, 40 or 50 ; in Rueport, 40 or 50 ; 
in Shaftsbury, 30 : in Bennington, 70 ; in Povvnal, 70 
or 80." 

« I have been credibly informed, that in Clarendon 
about 80 died ; in Castleton, 60 ; in Shrewsbury, about 30. 
By the statement of Dr. Bowen, of Reading, it appears, 
that 4i died of this disease from the first of January to 
the 10th of June 1813, and 29 of other complaints ; of 
which last number, were fifteen infants; four still-born, 
and eleven in fits, or unknown complaints. Four hundred 
cases of the epidemic and forty of the deaths, were after 
the first of March. The town contains about 1600 in- 
habitants." 

Our correspondent further remarks, that previous to 
the first of March, he bled from two to four times, from 
12 to 24 oz. each ; his success was very great. But 
after this time he bled but little. In the latter period, 
the pulse was hardly perceptible; a sense of suffocation, 
the surface pale and cadaverous, or more commonly, a 
bloated purple colour, similar to a finger with a ligature 
on it ; numbness, &c. From four to ten hours after the 
attack, the surface of the body would be often covered 
with spots or blotches like blood blisters ; some of the 
bigness of a pea, others the size of a man's hand. Total 
loss of sight, insensibility, and other signs of approach- 
ing dissolution are mentioned. Sixteen adults died with- 
in six, or thirty hours after the attack, twelve of whom 
before any medical aid could be procured. It is further 

10 



7* HISTORY OF DISEASES. CHAP. II. 

observed if the patient was put into a warm bed, &c. the 
fever arose with a pulse from 90 to 110 in a minute, 
bounding, but easily compressible.'' 

It might here be observed, that the pressure of calls 
upon our correspondent was so great at this time, that it 
might be impossible for him to bestow that attention 
upon individual cases, which their importance demand- 
ed.* I will take the liberty to mention again, that the 
disease assumed greater severity in this place at the 
above time, than it had before ; greater diligence was 
necessary to counteract its fatal tendency. The applica- 
tions ought to be earlier made ; more external warmth, 
and I think I am right in saying more blood will need to 
be lost, in the course of the disease, under proper restric- 
tions, to ensure a favourable issue. At this very period, 
I was severely attacked myself; it was not until four 

* The trials of Dr. Bowen, undoubtedly, were something 
similar to what Dr. Gridley expresses of himself at this time. 
" Amidst the incessant toils and cares, which in me alas I 
induced premature old age, I had no time to number the sick. 
During two weeks preceding my own sickness, the urgent calls 
of humanity would not permit me a moment to make my 
charges on book. My soul was elevated above the desire of 
gain. So numerous were the sick that it became impossible 
to attepd them in any proportion to their danger. The atten. 
dants from necessity, acquired the art of judging by the pulse 
and adapting remedies to its varying state. Heaven, equally 
merciful as just, did not permit a whole family to be sick at 
the same time." He further notes, 

" I am inclined to believe the pneumonic fever raged with 
greater mortality and to a greater extent, on the western side 
of the Green mountains, in some proportion to the greater 
prevalence of the spotted fever on the eastern side," 



CHAP. II. HISTORY OF DISEASES. 75 

full bleedings, were practised, that I gained tolerable 
ease. The same was done in many instances at this time 
by my suggestion, in oilier cases ; and also the disease con- 
tinuing very severe in the neighbourhood after my reco- 
very, I practised it three or four times, generally upon 
the same patient, wiih complete success. Bleedings, 
without a particular regard to external warmth and col- 
lateral circumstances, are often injurious. But more 
hereafter on this subject. 

I very much regret my not being enabled to make a 
more particular statement. Great difference exists in the 
number of inhabitants in different towns, and also, the 
number ot deaths by this disease. It must be considered 
a low estimate to say, that the towns throughout the 
state averaged 25 deaths. About 226 organized towns 
of six miles square, make 5,650 deaths. Add to this 
750 soldiers, which makes the number of deaths by this 
disease alone 6,400, in about five months.— Census for 
1810, 217,913 inhabitants. 

The latter part of the summer and the first winter 
months, a considerable number of cases of typhus fever 
occurred. Also several cases of cholera infantum. This 
last disease has prevailed more or less almost every 
summer, although it has not been particularly noticed 
before now. 

1814. 

The diseases of this winter were considerably similar 
to those of the winter of 1812 — 13, but not so numerous, 
nor generally so severe. Six patients were sick at the 
same time in one neighbourhood with pneumonic fever, 
in its most characteristic form. Scattering cases were 



HISTORY OF DI^Ea-E-. CHAP. II. 

met with all winter. Also a few cases of spotted fever. 
About the -20 th of February. I met a ease of the latter, in 
■ little girl* who ! to be unwell early in the 

morning, and took an emetic. b\ the assistance of the 
family. It had only a moderate operation, but she was 
expiring when I arrived, which was about five hours 
from the attack. 

Dr. Littlefield observes thai, in Bennington county, 
consumption or phthisis pulmonalis •• has occurred much 
more frequently in my practice, within five or six ; 
past, than before.'* I think that I have had three 
times as many cases within that time as I had for six- 
years before. I did not notice this remark until 
since penning my remarks on this disease. My opinion 
there is in conformity to that of some other physicians 
in thi ity. The remark is very important. It 

show that phthisis prevails more at certain 
times and in certain places, than at other times and 
places. If so. it establishes the position I have attempt- 
ed to lay down, with respect to the pathology of this 
disease. Or does a difference in the treatment in pulmo- 
nic fevers, in different sections of the country, occasion 
more or less cases of phthisis to follow such epidemics? 
The method of treatment most relied on by this gentle- 
man, and I believe others in the vicinity. was a free use of 
efllomd.very moderate bleeding.and mild diaphoretics. <xe. 

Mr. Strong, a member of congress, informs me, that the 
pulmonic epidemic, which affected the state of Vermont 
verely last year, and also the northern states general- 
ly, this year.was very prevalent in the middle and southern 
-tates. That he heard of it whilst at TAashington, from 



CHAP. IT. HISTORY OF DISEASES. 77 

different directions, and particularly from his brother, 
who lives near the mouth of the Ohio river, who inform- 
ed him, that about thirty died of this disease in his neigh- 
bourhood. It has been said to be very frequent in Con- 
necticut. 

By the politeness of Dr. Jonathan A. Allen, I am fa- 
voured with an account of the severe sickness in Wards- 
borough, in Windham county. This town is situated 
about twenty miles west of Connecticut river, and east 
of the high lands. " It is variously broken into gentle 
ascents and descents, or hills and valleys, beautiful and 
romantic. No large streams pass through the town, but 
several small ones, sufficient to carry mills. Many 
springs of pure water; no swamps or meadows of any 
size ,• no stagnant waters ; land moist and a dark loamy 
soil. A lofty mountain on the west is a barrier against 
the winds from the north-western points. The atmos- 
phere seems pure and salubrious." 

" The former diseases have been influenzas, fevers, 
dysenteries, &c. The diseases of last winter were pul- 
monic fevers, similar to those of 1812 — 13, but approxi- 
mating more to catarrh. Several cases of typhus o«- 
curred, nine of which proved fatal ; about the 10th or 
14th day, they generally assumed the form of pneumonia 
typhoides." 

" On the last of May the disease assumed a different 
form ; two of the first cases proved fatal ; the bodies 
suddenly ran into the putrefactive process. The coffin 
lids were very imprudently made open. The scent was 
very offensive to those who attended the funerals. In 
twelve or fourteen days from this time, from four to 



78 HISTORY OF DISEASES. CHAP. II. 

seven cases daily occurred for some time. But few of 
those who attended the interment escaped an attack." 

We cannot in this place make any remarks on the 
supposed contagiout ness of this disease. 

A summary of the symptoms of this fever, are head- 
achy especially over the eyes, acute pains in the limbs, 
abdomen, &c. chills, rigors, &c. numbness and coldness 
of the extremities, and preternatural heat in the head. 
Internal heat manifested by hot breath, &c. " The skin 
had a peculiar feeling, different from mere inflamma- 
tion." Pulse increased, &c. Delirium very common; 
« time lost by the patient, although he seemed rational." 
No proper crisis of the disease could be observed. 
Symptoms variable. If no abatement of the disease took 
place by the third week, the patient died. If a relapse 
took place, they would be sick much longer, and have 
symptoms of phthisis. In August, diarrhoea attended 
many cases. The attacks were sometimes sudden, at 
other times the patient would linger for a number of 
days. 

The number of those who have had regular fevers, 
after the first of June, was about two hundred, and about 
as many more had the disease arrested by bleeding, eme- 
tics, cathartics, &c. The account is dated Sept. 27th. 
It appears, the disease had not left the place at the time 
of writing. Our correspondent was confined eight weeks 
himself by the disease, and part of the statement was 
furnished by Dr. Wheeler, his partner in business. The 
treatment seemed to consist of a mixed kind, varying 
according to the circumstances of the case. Of the two 
hundred eases submitted to these gentlemen's directions, 
seven died. Six others also died under unfavourable cir- 



CHAF. II. HISTORY OF DISEASES. 79 

eumstances ; one, for instance, bled to death at the nose; 
one was unmanageable ; one died of eijnanche maligna ; 
not >cen by any physician ; two under adverse cir- 
cuit 

Also ten others died under the treatment of a noted 
quack, who used hot rooms, copious sweating, rum, ether. 
But a very few recovered by (his method. The 
whole number of deaths was twenty-three. 

This statement furnishes a brilliant specimen of the 
identity of hurtful principle, its progressiveness, and mu- 
tation of diseased affection. In the same season and 
nearly at the same time, prevailing pulmonary fever, 
: rhal fever, typhus or continued fevers of greater or 
■i ity, eynanche maligna, dysentery or diarrhoea, 
and phihisis pulmonalis ; and all these in a situation re- 
mote from ponds or stagnant water. Our views on these 
subjects will be developed in succeeding chapters. 

Angina parotiiea, or mumps, were prevalent the au- 
tumn of this year. This disease has prevailed at various 
times, although but little notice has been taken of it. 

Some dysenteries in this vicinity this year. In Read- 
ing about forty. Dysenteries have prevailed in the vici- 
nity of Danville, where a number of fatal cases have 
happened. Only a few severe cases in this vicinity. 

An unusual number of slight icteric fevers were met 
with, the latter part of the summer and autumn of this 
year. In general they required but little medical aid, 
A very slight fever could be discovered, and also a slight 
yellowness in the skin and eyes, whilst the patients were 
oftentimes able to attend moderately to business. Slight 
pains were common : hut not oftener confined to the ^tr 



80 HISTORY OF DISEASES. CHAP. If. 

mach or region of the liver, than to other parts. Slight 
emetics and moderate cathartics with an attention to 
promote perspiration, gave relief. Continued fevers have 
heen considerably prevalent the whole of the summer in 
this vicinity. They generally assumed what is called the 
typhoid character. If left to themselves, or treated with 
moderate internal stimulants, they would continue four 
or six weeks.* Emetics appeared to be of singular ser- 
vice. A very considerable proportion of cases required 
one, two, or three bleedings. Like former cases of simi- 
lar fevers, if the disease was early treated pretty rough- 
ly, its period would be greatly shortened. The disease 
did not seem to possess the severity, nor obstinacy, of 
continued or typhus fever of former periods. It disap- 
peared about the middle of November. 

Mention is made, in the New England Journal, of a 
fever in Massachusetts, the summer of 1814, very simi- 
lar to that which has prevailed in Vermont. See the 
above. Vol. iv. page 21. 

From a statement, made in the Richmond Inquirer, 
printed in Virginia, it appears, that a very severe epide- 
mic disease prevailed in that state, in December. It is 
called a contagious distemper. Some extracts from a let- 
ter to the editors, will give a short account of it ; dated 
county of Stafford, January 3, 1815. « The distemper 
is distressing beyond any thing you can imagine. It 
takes off whole families. I am fearful to send any of 
my family to Aquia. If the disease does not abate, I 

* Three cases proved fatal in this neighbourhood, all 
treated more or less with calomel and opium. One termi- 
nated in two weeks ; the other two in about four months, 
with unequivocal symptoms of phthisis pulmonalis. 



CHAT. II. HISTORY OF DISEASES. 81 

am apprehensive, that it will destroy the greater part of 
our inhabitants. In King George, there was a family of 
ten ; the whole died exeept a little boy, who went to a 
neighbour's house, after starving a day or two, aud ask- 
ed for some bread. He was asked if he had not a plenty 
at home ; he said that his father, mother, and the rest of 
the family were asleep, and that he could not wake them. 
He was asked how long they had been asleep ; he said 
a day or two. The neighbours went over and found nine 
of them dead ! They were so much alarmed, that they 
concluded it would he best to set fire to the house, and 
burn them up; which was done!" 

•• The alarming disease, noticed in the above, has ex- 
isted for several weeks in some portions of the seaboard. 
In the Northern Neck especially it ha9 made the great- 
est ravages. It frequently kills in from six to twelve 
hours. It principally preys upon the most robust habits. 
Some describe it as a typhus fever ; others as a violent 
inflammatory sore throat ; the most of them as a putrid 
sore throat. It affects the throat most violently, and 
obstructs the circulation of the air through the wind- 
pipe. In a few instances, as the one above stated, the 
houses in which the dead have lain, have been burnt 
down to prevent the diffusion of the contagion."! This 
savours too much of imported misconception. 

A few days after the above, a statement was published 
by Dr. Trent. He calls it epidemic sore throat. He 
considers the disease to be similar to the malignant influ- 
enza, which prevailed last winter in the same neighbour- 
hood, with this difference, that now the force of the 

11 



82 HISTORY OF DISEASES. CHAP. II. 

disease falls upon the throat, instead of the lungs, there- 
by endangering suffocation. He does not think it to be 
croup, nor the putrid sore throat. 

The remarks of this gentleman appear to be pertinent 
and philosophical. "Whether the disease affects the head, 
breast, or throat, he proposes blood-letting. "The pulse 
at the beginning is small and contracted: one or two 
bleedings, until the patient feels faint or sick, will make 
it full and soft." A valuable remark. By moderating 
the violence of fever in the beginning, he thinks to avoid 
effusion of coagulating lymph on the brain, lungs, and 
throat. The next indication is to excite moderate per- 
spiration ; emetics, cathartics, blisters, kc. " These 
measures boldly and promptly applied, seldom fail to dis- 
arm the disease of all its terror.'' It may be observed, 
that whether the disease be epidemic angina or not, the 
above method may be most eligible. This last disease 
has been absent from this country about ten years. 

On the 28th of November, at ten minutes past seven 
o'clock in the evening, was experienced a small shock of 
an earthquake : it lasted about thirty seconds. AVhilst 
writing in my chamber the tremulous vibrations were 
perceived very distinctly, attended with rattling of win- 
dow s, and window blinds : a rumbling noise in the earth, 
&c. Fevers are not so common at this time, as a few 
weeks past. 

In the month of December a few fatal cases of spotted 
fever were heard of in this state ; one in the soutli parish 
of "Woodstock, three in Bridgwater, and one in Hartland. 
Also in Xew Hampshire, it is said to be prevalent 



CHAP. II. HISTORY OV DISEASES. 83 

in many places, as at Acworth, Amherst, &c. proving 
fatal oftentimes in twelve or twenty-four hours. 

Catarrhal fever lias heen considerably prevalent in 
December and the fore part of January. 

A chronic swelling of the thyroid gland called goitre 
is occasionally met with. This disease is not so common 
as it was in the first settlement of the country. 

The foregoing is considered only as an imperfect no- 
tice of diseases in this section of the country. Time 
and opportunity may render it more complete. Perhaps 
enough is inserted to mark the most interesting periods 
of sickness. 

|C7*The author improves this opportunity to tender his 
grateful acknowledgments to those gentlemen, who have fa- 
Youred him with materials for aiding the design of this chapter. 



CHAPTER III, 



A CONSIDERATION OF THE SEVERAL CAUSES OF FEVER. 

INTRODUCTORY. 

The acquired knowledge of mankind must be consi- 
dered as progressive, not only as it respects individuals 
from infancy to mature age, but also as it respects com- 
munities in all ages ; as may be learnt from authentic 
history. The progress of the arts and sciences, as well 
as the knowledge and cure of diseases, has been slow, 
and more or less subject to doubt and uncertainty, which 
has given occasion for much speculation and reasoning, 
as well as no small share of disputation, and even invec- 
tive. 

It is unfortunate for the healing art, that almost every 
other design of man has preceded this in point of atten- 
tion and improvement. Self-preservation, the gratifica- 
tion of ease and sordid passions, such as avarice, usurpa- 
tion, revenge, &c. together with the auxiliary means of 
obtaining these, has been, in different periods of the 
world, the great leading object in the pursuit of man. 
As a consequence of this, the attention of mankind, in 
the early ages, was directed to the investigation of the 
grosser properties of matter, and particularly to im- 
provement in the mechanic powers ; together with astro- 
nomical observations. Having advanced to a considera- 



CHAP. HI. CAUSES OF FEVER. 85 

ble degree of attainment in these, and when the subject 
of physics, as it relates to animal life and disease, began 
to be attended to, every thing in the human economy was 
attempted to be explained agreeably to the laws of inert 
matter, and the gross action of mechanic powers. It 
was reserved for modern philosophers to suggest, that 
animal matter, whilst endowed with life, was governed 
by laws peculiar to itself, and to be explained upon prin- 
ciples of its own, independently of every other form of 
matter. With so many embarrassments to the progress 
of medical knowledge, and many others, that might be 
added, the science of life, health, and disease, has linger- 
ed long behind the rest. 

The investigations of philosophers and chemists,within 
half a century past, have done much to enlarge our 
views of the great and secret operations of nature, in 
the material world, and unfolded to our perceptions, 
through the agency of the different gasses, and electrical 
fluids, the most astonishing, as well as useful phenome- 
na. But all these very active and subtle bodies may be 
considered as material and ostensible ; their agency can 
be discerned, and, in part, demonstrated. With this 
acquisition to medical philosophy, we are but little bet- 
ter, than taught our ignorance of the deleterious prin- 
ciples, or invisible agencies, that affect the actions of 
living bodies. These have, hitherto, eluded the most 
elaborate researches, and microscopic observations. We 
have, therefore, to reason from tlie effect to find the 
invisible cause ; that is, seeing that the living bodies of 
mankind are, under certain circumstances, thrown into 
commotion, with a derangement of the regular func- 



86 CAUSES OF FEVER. CHAP. III. 

tions, and attended with different effects, as weakness, 
pain, and death ; we are induced by a sense of prudence, 
as well as curiosity, to find the principle and modus ope- 
randi of the agents, that have induced these hurtful 
changes. In these inquiries, the result has been very 
different among those that have been engaged in them ; 
notwithstanding, many improvements have been made, 
and much light has been thrown upon the subject, by 
collections of facts. And perhaps, if the investigations 
and improvements could be arranged in suitable order, 
and put in some different and conspicuous point of view, 
they would appear less irreconcilable. 

SECTION I. 

Definition of hurtful Principles, and miscellaneous Obser- 
vations. 

Much ambiguity, perplexity and uncertainty have ex- 
isted, in the mind of the reader, as well as in writers, 
on account of the vague and indefinite manner in which 
words have been used to convey ideas of the different 
kinds of noxious principles inducing disease. It will, 
therefore, be necessary to define particularly what we 
are to be understood to mean, when we use the words 
contagion, infection, miasmata, &c. The originals of 
these words convey nearly the same ideas; we shall, 
therefore, pay no attention to these, and continue to use 
them, because they have been so long used, and become 
familiar. 

It will then be understood, that the word conta- 
gion, will be used to denote and specify that principle, 



SECT. I. CAU9ES OF FEYER. 87 

which is the effect of living organic systems, labouring 
under disease, whereby its like is produced, and may be 
eliminated from the diseased body in a subtle gas, or by 
contact, and produce its likeness in a healthy body, by 
its own generative and specific powers. The diseases, 
that belong to this class, are the small-pox, chicken- 
pox, measles, hooping cough, mumps, &c. 

Infection will be understood, to denote that principle, 
which is the effect of living organic bodies, labouring 
under disease, wherein by an assimilating process, its 
like is produced, and may be communicated to a healthy 
body by contact alone, where its likeness is reproduced 
of a specific character. The diseases that belong to 
this class, are hydrophobia, syphilis, psora, lepra, &c. 

Miasma will be used to express that principle, which 
is the effect of animal and vegetable decomposition and 
corruption on the surface of the earth, within the at- 
mosphere of such decaying bodies, &c. eliminating 
therefrom in the form of a subtle gas or effluvia. 

To these, it seems proper to notice, that the word me- 
phitis will be used to express all those noxious princi- 
ples, which, at certain times, and perhaps often, arise 
from the surface or bowels of the earth, and are un- 
friendly to living animal bodies. 

The derivative, pestilential, will be used to express the 
deleterious properties, qualities, or essences, that may 
be generally diffused, and, at particular times, increas- 
ed in the atmosphere ; without meaning, by this term, 
to convey any idea of their specific properties. 

The operation of some one, or a conjoint operation of 
some of the three last sources of hurtful principles. 



88 CAUSES OF FEVER. CHAP. III. 

will be assigned the cause of predisposition to those fe- 
vers,, more strictly called epidemic, or elementary ; such 
as influenza, intermitting fever, typhus fever, dysente- 
ry, epidemic peripneumony, angina epidemica, spotted 
fever, yellow fever, plague, &c. 

As the diseases, comprehended under the influence of 
contagion and infection, do not come within the scope of 
this work, they will be but little noticed ; as the princi- 
pal design is to investigate what are denominated epide- 
mic fevers ; and these, it will be suggested, have their 
origin primarily, and individually, from a concurrence 
of the agencies of the miasmatic or mephitic and pesti- 
lential influences, in connection with exciting causes. 

Perhaps some other word might be substituted in pre- 
ference to epidemic, to express the character of the class ; 
but, as we are not fond of coining new words, when old 
ones will answer, this will be continued as most agreea- 
ble to custom, and the common understanding of man- 
kind ; notwithstanding, they prevail sometimes, as ende- 
mics, or pandemics. Possibly the qualifying word ele- 
mentary, would be more expressive. # 

Miscellaneous Observations. 

It may be observed here, there is some reason to 
believe, that all the contagious and infectious diseases, 
have their origin from some extraordinary concurrence 
of circumstances, or contact of contrarieties, favoura- 
ble to the generation of new productions. When once 

* Perhaps the noxious gases from decomposing bodies 
may well be called elementary principles, or not susceptible 
of any further decomposition, or division. 



SECT. I. CAUSES OF FEVER. 89 

the assimilating process has commenced, it continues to 
progress in an individual, and convert matter, suited to 
its aifinitv, until the same principle is reproduced. If 
any one system should be contaminated, for instance, 
with the small-pox, or syphilis, it is an acknowledged 
fact, that this assimilating principle will produce the 
same result, ad infinitum, all circumstances being equal. 

Like every thing else in the great system of nature, 
diseases may be subject to change their character. 
Some of the diseases of the present age, which stand 
high in the catalogue of human woes, were not known in 
ancient times. The history of the diseases of those 
times is rather imperfect, but from what we can learn, 
they were not altogether such as appear at present. 
The small-pox is of modern date. Mead says, page 308, 
who quotes Kiske for his authority, " this year in fine 
(A. D. 572), the small-pox and measles made their first 
appearance, in Arabia. Allionius observes, that the 
gangrenous sore throat was but little known before 1610. 
The scarlet fever appears to be of still later origin. 

The syphilis was not known in the history of diseases 
until about the year 1494, when it was said to be import- 
ed into Spain, from South America; others say from 
Holland. It must seem strange, if this disease were 
prevalent antecedent to this time, that there should be 
no account of it; it appears equally surprising that it 
should be taken from the natives, when they appeared 
to be strangers to it ; and long after, Ulloa, in a voyage 
to South America, asserts, Book vi. that « the venereal 
disease is seldom known among the natives." A disease, 
that destroyed thousands before it was understood, and 
the best method of cure discovered, would, undoubted- 

12 



90 USES OF FEVER. CHAP. III. 

Jy, have arrested (he attention of the historian before 
the year 149*. Does not the origin of the kine-pox fa- 
vour the idea, that eontrarieties, or opposite principles, 
may produce a new disease ? This appears to he produc- 
ed from a filthy humour of the herpetic kind in horses, 
passing the process of organic diseased action in the cow. 
It is an hybride, possessing the specific character of the 
small-pox, in requiring a determined time to pass through 
the system, and an affinity to syphilis in being propagated 
only by contact. May it not be conjectured, that syphilis 
had an origin, in some measure, similar ? This supposi- 
tion appears to be confirmed by the circumstance, that 
both the Europeans and Americans were strangers to this 
disease before their intermixture. A disease having 
some resemblance to this affected the Spaniards, previous 
to having commerce with the Indians, called burning, 
which was said to require legislative restraint ; more, 
however, from prudential and municipal motives, than 
fro in an alarm of its mortality. 

There was a time, undoubtedly, when contagious and 
infectious diseases were strangers to this earth ; they 
have had an origin, at different times, by a concurrence 
of causes unknown to us. It is sufficient for our pur- 
pose to learn their present character. Although the 
appearance of these classes of disease is not precisely the 
same in all seasons, and in all habits, yet they manifest- 
ly have a determined character, and are nearly alike at 
different times. Those, that are assigned to the class of 
contagion, require about the same term of time to run 
through the system now, that they did centuries ago $ 
those of the class of infection are governed by the same 
laws now, as in former times. 



SECT. I. M*S 0F FEVER. 91 

It is believed Ihere is little doubt, but thai most, if 
not all. the diseases of these classes may be generated, 
in eertain places and seasons, from a recurrence of the 
causes, which first produced them in former times; and 
that they spread from one person to another, and become 
epidemic more or less, according to the particular state 
of the atmosphere, favouring their propagation. But 
the productions of these kinds, are very rare, and their 
existence not attended with a satisfactory proof, which 
is sufficient to gain the full assent of the mind; the 
most we know of them is, that they are propagated by 
a seminal influence ; and probably were instituted for 
the scourge of man. 

With respect to those diseases, that we called epidemic, 
every term of experience serves to convince, that they 
are very mutable in their character. Where a con- 
course of symptoms designate the disease in popular 
language, the discerning physician often discovers a dif- 
ference from those, which he has seen on former occa- 
sions, called by the same name. This is so manifestly 
the case, that hardly any two epidemics are said to be 
exactly alike ; at any rate, they have not the specific 
character of the fevers from contagion. This difference 
is imputed to some variation in the predisponent princi- 
ple. It is agreeable to the analogy, observed in the ani- 
mal and vegetable kingdoms, to suppose, that even the 
diseases of the most specific character, become extinct, 
and that others are generated from the operations of 
physical causes. Species of animals did exist in former 
times, as we learn from authentic history, that have 
now become extinct, and those of the most perfect kind. 



92 CAUSES OF FEVER. CHAP. III. 

Certain insects and reptiles, are produced, on certain 
occasions, from a concurrence of circumstances unknown 
to us, which seem to be of a different character. They 
are creatures of a day, as it were, some of them real 
ephemeras, others of longer duration. All of the same 
species, alike in colour, size, and duration ; myriads 
congregate together, and become extinct together. We 
have abundant reason to suppose, that these are the 
productions of certain elementary principles ; the par- 
ticular combinations of matter, however, are wholly 
unknown to us. An analogy is here presented worthy 
of our attention. As animals of a higher class and more 
determinate character, have the power of procreation, 
and of perpetuating their own species; and others come 
without any known seminal influence, but by a concur- 
rence of appropriate elementary principles ; — so certain 
diseases, of the contagious and infectious character, per- 
petuate their existence under all circumstances; whilst 
the epidemics, from a determinate opposition of elementa- 
ry affinities, are produced only at such times, as favour 
their production ; and are perpetuated only by the exis- 
tence of the adventitious causes, which produced them.* 

* There need be no suggestion here that such a sentiment 
is limiting the Providence of God. Whatever the manner 
may be, which he takes to bring about his own designs, his 
Omnipotence is made equally manifest. Our object is to try 
with Pope, to 

" Look through nature up to nature's God." 

If by the power of his word he is able to uphold " all things 
that are made," he is able to change their habit of existence, 
or give to matter the property of reciprocal action. All this 
should serve to magnify our views of His wisdom and power. 



SECT. 1. CAUSES OE FEVER. 93 

It appeared necessary to make the foregoing general 
observations, respecting the origin and perpetuation of 
the diseases, that we have thought proper to place under 
the classes of contagion and infection. They will now 
be dismissed, with the reservation, however, of referring 
to them occasionally by way of illustration. 

We are fully apprized of the danger of classing dis- 
eases in the ordinary method of nosological arrangement 
according to the different types or states of the system, 
that have been assigned to particular diseases. This 
has been a source of infinite error. It was considered 
more appropriate to make only some general classifica- 
tions of fever, founded on their remote causes. If one 
reasonable argument can be urged in favour of this 
mode, it will be full as much as can be said in favour of 
the common nosological arrangements. One important 
benefit in a classification by remote causes, will be to draw 
a discriminating line between those diseases that may 
have a foreign origin, and those that may have a do- 
mestic or elementary origin. The former may be trans- 
ported from place to place, and may be communicated, 
under all circumstances; whilst the latter are suscepti- 
ble only in certain places, or under certain circumstan- 
ces. For the want of this discrimination, great discor- 
dance of opiuion has prevailed among physicians ; and 
much perplexity has arisen in different countries in pub- 
lick and private concerns. From an apprehension, that 
certain diseases of an epidemic character are contagious, 
the sick have been abandoned to their fate by friends 
and physicians ; the common acts of hospitality, and the 
necessaries of life, and a common burial, have been 
denied them ! 



9* CAUSES OF FEVEK. CHAP. III. 

Tedious and oppressive quarantines have been esta- 
blished to the great injury of commerce, and annoyance 
of individuals. It will not be denied, but that quaran- 
tines, of short duration, may be necessary, for the 
purpose of cleansing ships, wearing apparel, &c. of 
every impurity and fermenting principle, whereby mias- 
mata may be produced; the same as in streets or houses; 
but forty days' detention for the purification of the bodies 
of men, is useless in epidemic fevers ; and the restric- 
tion had its origin in a profound ignorance of the laws 
and principles that govern epidemic diseases. 

The folly of adhering to nosological arrangement is 
conspicuous in this; that, almost always when an epi- 
demic is present, the type of disease is different in differ- 
ent cases, and in the same case at different stages ; for 
example, when an epidemic angina prevails, some cases 
appear more distinctly in the character of what is called 
synocha, and others more distinctly in that of typhus ; 
and also the states of the system are often so blended 
between the two extremes, that it is believed the most 
acute nosologist is put at much strife with himself, to 
determine, which genus to place it in. It is divided 
sometimes, and the mean difference is called synochus. 
Dr. Cullen, with all his nosological ingenuity, would 
find no place for putrid fever; notwithstanding it was 
so common, and often appeared in intermittent fever, 
&c. His other works stand, perhaps, unrivalled. It 
may be added, that nosology would be, at least, innocent, 
if it did not lead the student to prescribe for names, and 
neglect the degree of morbid excitement and real cha- 
racter of the disease. 



-KCT. II. ' W*X *> F FEVER 95 

The disease should be treated according to what it 
is, ami not according to any generic character it may 
have forced upon it. The spotted lever seems yet unac- 
customed to the yoke of nosological restraint, notwith- 
standing tlie attempts to subdue it. Perhaps there is no 
disease in history, that is so variable in its phenomena, 
and requires such versatility of treatment. It is a con- 
spicuous example of the variety of febrile action, and is 
well calculated to test the skill of the physician. 

SECTION II. 

Elementary or Epidemic Diseases not contagious. 

As opinions have been circulated from respectable au- 
thorities, that certain of the diseases, if uot all of those, 
that are assigned to the class of elementary or epidemic 
diseases, are propagated by a specific contagion from 
one person to another, it appears to be incumbent on 
the writer to assign his reasons to the contrary. They 
are the following. 

The diseases of acknowledged contagion have a specific 
character, are of a certain duration, and affect people but 
once in the course of their lives. 

Those of the epidemic character are more variable 
in their symptoms, are of uncertain duration, and affect 
people more than once in the course of their lives. 

Diseases of the epidemic character cannot be propa- 
gated, except under certain states of the air, which 
favour their spreading. 

The diseases, strictly called epidemic, are distinguish- 
ed from the contagious by these circumstances; that 



96 CAUSES OF FEVER. CHAP. III. 

they are often only propagated at certain seasons of the 
year ; whilst the contagious are but little affected by 
this ; as also that the epidemic affects certain classes of 
people, such as natives, or strangers, or children, whilst 
other classes are not affected. The known contagions 
have no such respect to persons. Almost innumerable 
instances might be mentioned, from good authorities, 
as also some from present recollection, where diseases 
have arisen of a determinate character, such as dysen- 
tery, typhus, angina, yellow fever, spotted fever, and 
even plague, where one, perhaps three or six, in a fami- 
ly, have had the disease, and it then ceased, no others 
taking it from them. 

According to writers of the best authority, persons 
affected with plague or yellow fever, upon being remov- 
ed to a clean habitation, and out of the sources of conta- 
mination, never communicate the disease to others. 
This of itself might forever put the question at rest. 

It is the character of contagious diseases to perpetu- 
ate themselves under all these circumstances. What 
has been said above may be applied to all the other dis- 
eases called epidemic. In the course of twenty-five 
years practice, I have seen most of the diseases called 
epidemics, prevailing more than once or twice ; and I 
am ready to aver, that not in a single instance, could 
the disease be traced unequivocally to contagion. It is 
sometimes the case, that a whole family will have the 
dysentery or angina; typhus or spotted fever; but it 
is as often, that only one in other families will be af- 
fected. It is common for about half a family to have 
the dysentery, angina, or spotted fever. When the last 



imCT. II. CAUSES OF FEVEH. 97 

of these was epidemic in this place, in the winter of 1811, 
one half of my family, consisting of ten, had the dis- 
MM ; the others escaped. This would he a rare occur- 
rence in small-pox or measles ! 

It is common for the attendants on the sick to be 
affected with the same disease, in the time of epidemics. 
They are undoubtedly more exposed to the exciting 
causes of disease than others; such as fatigue, cold, 
anxiety, and often depression of mind. With this liabili- 
ty to disease, it is rare, in the country, to find the atten- 
dants attacked much oftener than others, that have not 
been exposed; and one fact is certain — I have known 
people attacked various times with typhus fever, dysen- 
tery, angina, and spotted fever, when these have prevail- 
ed epidemically, who lived several miles from the abodes 
of any other human beings, in the woods; and who had 
not any sort of personal communication after the break- 
ing out of the epidemic. 

Some who deny the yellow fever to be contagious, still 
think typhus fever is so ; but this mistake vanishes upon 
a review of all the facts. Yellow fever runs its course 
very rapidly; there is not time for the production of 
that material which has been denominated idio -miasma' 
ta, from fermenting excretions, &c. which is liable to 
bappen in the protracted state of typhus fever.— But this 
is a circumstance of little importance, as the miasmata 
only give the predisposition to disease, and the exciting 
causes may be avoided, and cleansing may be practised 
to destroy the miasmata. But granting all that may be 
said, relative to the production of this kind of miasma; 
it does not possess the character of contagion ; for the 

13 



98 CAUSES OE EEVEK. CHAP. III. 

lime of its access is not defined. Tt has no determined 
time to run its course ; it affects people more than once; 
and but few receive the impression who come within its 
influence. When it happens to invade a family, it is 
often the case that many have it ; but perhaps not more 
than might be supposed to have any other epidemic, 
where contagion will not be insisted on ; having respect 
to the length of time. This disease having been very 
prevalent in this part of the country, particularly from 
1797 to 1809, has given me mueh opportunity to observe 
whether it be contagious. From much attention to this 
part of the subject, I am ready to say, that it has not 
appeared to be communicable from one person to ano- 
ther, any more than the other epidemical diseases ; nor 
is it common for a greater number of the same family or 
attendants to be seized with it. Furthermore, it is a 
fact, that typhus, in common with all the pestilential or 
elementary diseases, may be shortened in its course. It 
may be wholly arrested and eradicated from the system 
in a few days, near the beginning of the disease, and 
sometimes, after considerable contiuuance. At the same 
time, left to itself, or aggravated by improper treatment, 
it may last for months. This is not the course of fevers 
from known contagion. See Chap. x. latter part seet. 1. 
I have known persons affected with angina epidemica, 
more than once. In the case of a young woman at 
Bethel — she had the disease distinctly three times in the 
course of about twelve months, in the year 1796. In 
several other cases I have seen the disease twice, dis- 
tinctly marked, in the same person. The disease of this 
season, angina raged very generally, and several aged 



SECT. II. CAUSES OF FEVER. 99 

people Lad it, who said they had had it in former periods. 
A young woman observed the same in 1803. From these 
and other facts, as that of several persons in Bethlehem, 
being affected, first in the year 1793, and again in '94, 
(Med. Repos. vol. i. p. 525,) 1 am firmly of the opinion 
that the human system is resuscepiible of the disease. 

Angina maligna, or rather epidemiea, described as 
appearing in New Hampshire, in 1735, « very few chil- 
dren escaped, for although the disease was very infec- 
tious, yet its propagation depended very little on this 
circumstance. It attacked the young in the most se- 
questered situations, and without a possible communica- 
tion with the sick J" Belknap's History. 

It is very common for persons to have the spotted 
fever more than once. Hardly any epidemic is more 
liable to relapse. This will not be controverted. 

The plague is also produced and propagated by a pes- 
tilential state of the atmosphere, and is liable to affect 
people more than once. Mr. Webster is chiefly a com- 
piler, but his authority is good : he says, vol. ii. p. 139, 
" it is admitted by all correct observers, that the plague 
may be received by the same person, times without 
limits. A person in Constantinople died of the twelfth 
attack ; and many persons in the late plague in America 
have been affected two or three times." 

Dr. Mosely declares from his personal observation, 
that the plague is not contagious.* 

* In an account of the late plague in Malta, as described 
by Dr. Faulkland, the symptoms of the disease seem perhaps 
well enough described, and which bear a strong resemblance 
to our spotted fever. It is ludicrous to notice the serious 



100 CAUSES OF FEVER. CHAP, III. 

One further suggestion may be attended to in this 
place. It is observed by many writers, it* not all, that 
at the close of an epidemic season, the cause, whatever 
it might have been, becomes weaker, and those that are 

observations, that the Ci British practitioner'* makes on the 
contagiousness of the disease. (See N. E. Journal of Med. 
and Surg. vol. iii. p. 345.) He says, " whilst some persons 
are stated to have been attacked almost immediately after 
the noxious contact, others were represented to have continued 
well an incredible length of time before any symptoms became 
evident." This obsequious, but honest contagionist, says, a I 
have myself noted patients taken from the bosom of their 
families in the most distressing disease, and with perfect impu- 
nity to those with whom they had communicated ;— children 
from their mothers, and husbands from their wives. Yet these 
families had used no kind of precaution whatever, not so much 
as an attention to common cleanliness." Many similar instan. 
ces are related, which prove the disease to be governed by the 
same laws as other epidemics. He seems to think the infec- 
tion is only received by contact, " directly or intermediately." 
The sick he thinks must not be approached without " an oiled 
silk dress." The laws are such, that the penalty for a physi- 
cian " for feeling a pulse even through a tobacco leaf, with 
every possible precaution, was not less than fifteen or twenty 
days quarantine." What insufferable stupidity ! Can it be 
a matter of astonishment, that no more progress has been 
made in the treatment of this disease, when we see physicians, 
magistrates, and the ignorant of all classes, combined against 
truth ? There never has been any greater evidence given to 
the world of the contagiousness of the plague, than that of 
yellow fever; nor any more of this last, than that of spotted 
fever. Our grave author further says, he u knew reinfection 
take place three times in one individual." It is very likely 
the man had the disease three times ; and we are willing to 
credit facts, and this may be one ; but it is time that the absurd 
and fatal theories of the old schools were called in question. 



SECT. III. CAUSES OF FEVER. 101 

affected generally suffer less, than in the first or middle 
periods of the epidemic season. This does not look like 
the character of specific contagion ; — it can be more ra- 
tionally solved in a view of the state of the air, approxi- 
mating more to a state of salubrity ; — and furthermore, 
the bodies of men have become a little more accustomed 
to the pestilential atmosphere. 

It is believed, that with respect to the other diseases, 
named in the class of epidemics, no body will deny, that 
the system will be again and again susceptible of the 
disease. 

If diseases of this class are propagated by a contagious 
principle, it is of a singular sort ; not subject to the laws 
of any known contagion. But we hope to be able to 
assign their origin in a satisfactory manner to the can- 
did and discerning, which will be our next attempt. 

SECTION III. 

Remote influences affecting the system which increase the 
liability to disease. 

Although we cannot comprehend but a part of the 
agency of nature, nor explain the whole of the properties 
of matter, we can observe a fitness and agreement in 
many things, and make useful deductions for our own 
benefit and safety. 

The properties of matter are, in part, understood, and 
we discern an attracting and repelling power in many of 
the objects around us. Perhaps these properties are the 
most conspicuous in the electrical fluid, and its different 
combinations, of any known principle. 



102 CAUSES OF FEVER. CHAP. III. 

The atmosphere, which is the medium in which man- 
kind exist and move, is a compound of various constitu- 
ent principles, subject to much variation, and is conti- 
nually changing. Some of its parts contain principles 
absolutely necessary to the comfort and health of the 
body; whilst other parts contain principles actually 
and directly destructive to the health and existence of 
animal life. An excess of either of these, produces dis- 
comfiture in the system ; and perhaps it is only from a 
due admixture of these qualities, that we experience that 
state of the atmosphere, which is found by experience to 
be friendly, and which we call healthy and agreeable to 
animal life. 

The general connection between cause and effect is 
so admirably established, that this great mass of aerial 
fluid is well adapted to give energy, vivacity, and nutri- 
ment to animal bodies. 

Notwithstanding these consequences are most com- 
monly the effect of decomposition and new combination, 
that constantly go on in the principles of the surrounding 
atmosphere ; yet these operations are sometimes, aud not 
unfrequently, diverted from their regular course ; and in 
proportion to every such deviation, an effect is produced 
by our atmosphere commensurate with the degree of 
derangement. 

The mean temperature of this latitude is found by ex- 
periment to be 43|°. Suppose, for the present, by some 
change unknown to us, the mean heat should rise to 
bo\°. It will be admitted, that an astonishing change 
would take place on the surface of the earth and in its 



SECT. III. CAUSES OF EEVER. 103 

atmosphere. Suppose it should he reduced ten degrees; 
the change on the other hand would he equally great, 
as will he admitted by all. These are put as strong ex- 
amples ; hut it ought to he admitted that every degree 
of change, in other respects, heside heat and cold, even 
the smallest, will produce a proportionate difference. 
Again, if there be an attractive and repulsive influence 
between the sun, comets, earth, moon, and other plane- 
tary systems, as is asserted and even demonstrated by 
philosophers ; and if these properties are varied, and 
their influence increased or diminished according to 
proximity and other circumstances ; it forces a violent 
presumption upon the mind, that these alterations may 
produce a change in the atmosphere around us. 

It will be acknowledged,with respect to light and heat, 
that we receive the greatest portion of these in the nearest 
approximation of the different planets to our earth, cete- 
ris paribus, A comet becomes very conspicuous to our 
sight, when in its perigee; but we can discern nothing of 
it when in its apogee. In like manner we may conclude, 
agreeably to the laws of matter, that the attractive and 
repulsive powers of the heavenly bodies have their influ- 
ence in other respects increased or diminished in propor- 
tion to their proximity to our atmosphere. 

In the ordinary revolutions of the planetary system, of 
which our earth is a part, the order is very harmonious- 
ly established, and we have become familiar to the chan- 
ges of different seasons of the year, by the annual circuit 
and inclination of the earth in its orbit; to the different 
phases of the moon in her monthly revolutions ; and to the 
different phenomena of day and night, by the diurnal rota- 



10* CAUSES OF FEVEtt. CHAP. III. 

lion of the earth on its axis. These changes are manifestly 
very great, and have an indisputable controling influence 
in regulating and in producing the various seasons of the 
year, as respects the sun \ in causing the ebbing and 
flowing of the tide, as respects the moon ; in producing 
the diurnal revolutions in the human body, as respects 
the daily revolution of the earth every twenty-four hours, 
as is recognized by most physiologists. Certain diseases 
originate at certain seasons of the year, and stop at the 
approach of a different season, &c. 

Many other effects of these revolutions might be no- 
ticed, but the present argument is to show, that our at- 
mosphere, and the bodies of men, are greatly influenced 
by the established revolutions of the planetary system. 
As this is a point that will not be much controverted, 
with respect to the sun, moon, and earth, these will be 
hastily passed over to the consideration of some of the 
more remote bodies, moving in the vast expanse of ether, 
or rather, in the unlimited atmosphere of. the electric 
fluid, extended through indefinite space. The principal 
of these, that may be considered as having the most ma- 
nifest power in varying the attractions of our system, 
are the comets. The body, or nucleus of a comet, is 
said by astronomers to be solid, opaque, and possessed of 
a great degree of density, and capable of being heated to 
a great degree. They have a very highly electrified at- 
mosphere, extending to a great distance. They move in 
very eccentric elliptical orbits. As the sun is the com- 
mon centre of motion, and their circuits are in all direc- 
tions from it, they are sometimes near our earth, and 
sometimes at a very great distance from it, in the remot- 



SECT. III. CAUSES OF FEVER. i05 

est parts of their orbits. Their periods are very diffe- 
rent ; one having a period of 575 of our years ; another 
7 5 only; perhaps some have longer, and others shorter 
periods. 

Their approximation to our earth in their perihelions, 
is different according to the direction of the central part 
of the orbit from the sun 5 so that in performing their 
revolution, some of them approximate nearer our earth 
than others. The comet of 1577 came within a million 
of miles distance. 

It may be suggested by some, that although some of 
these wandering bodies are near to us, yet others are as 
far distant ; so that the equilibrium in the great system 
may be kept up. This does not appear to be always 
correct ; they are acknowledged to be very irregular pla- 
nets by all astronomers, and do not have that equal 
balance in the solar system, that the other well defined 
planets possess; and if, on the great scale, the equilibri- 
um is kept sufficiently well for the preservation of order, 
yet it must be granted, that variations of sufficient impor- 
tance happen, to derange the attraction of the regular 
moving planets of less magnitude ; and if this derange- 
ment is not sufficient to move the neighbouring planet 
out of its orbit, it may be sufficient to alter the state and 
condition of the surrounding atmosphere, and produce 
many and unusudl phenomena, which might not have 
happened under other circumstances. On this presump- 
tion, or rather, on this fact, is founded the theory of re- 
mote circumstances in the planetary system, hy natural 
cause and effect, producing changes in the bodies of 
men, which they are not accustomed to bear ; and affect- 

14 



106 CAUSES OF ¥EVER. CHAP. III. 

ing the tone of the living fibre, producing an approxima- 
tion to disease, and, from slight circumstances, actual 
disease.* 

In the year 1618, four comets appeared ; and again 
for several years, there may be no appearanee of any. 
According to lliveriiis, great sickness prevailed this year. 

It seems to be agreeable to the principles of philoso- 
phy, to suppose that such great bodies, and electrified 
atmospheres, as comets possess, should have an influence 
upon neighbouring planets, more or less, in proportion 
to their proximity and magnitude. This is agreeable to 
all the laws of attraction and repulsion in other matter. 
But in these matters of weighty consideration, we must 
not found an hypothesis on supposition $ we must have 
recourse to observation and fact. 

* Notwithstanding the general causes operate in an exten- 
sive manner, producing the predisponent condition in the 
atmosphere of insensible qualities ; yet we are, in a measure, 
influenced by the sensible qualities of the atmosphere, particu. 
larly by heat and cold. Although it is believed by us that 
more importance has been attached to these than they deserve, 
yet by operating as a change of climate may have some effect. 
The statement of Mr. Fitch, President of Williams' college, 
as published by Dr. North, makes it appear, that the summers 
of 1809 and 1810 were colder by 1° 75 through the whole 
summers, than the two preceding summers. This probably is 
the true difference, and agrees with the judgment of every one 
that these summers were colder. It may be noticed, that the 
spotted fever began more than two years before the first of 
these summers ; and was most severe a year or two after. 

It still remains a question to be decided, whether the ab- 
sence of heat and accumulation of cold make the change in the 
living body ; or whether the remote influences, which produce 
this difference in our atmosphere, may not rather be considered 
the ascendant cause ? 



SECT. III. CAUSES OF FEVER. lOT 

To make a complete collection of facts from past ages 
is difficult on account of these phenomena not being all 
recorded. Perhaps enough are recorded to establish the 
position in the minds of the candid; if not, let further 
observations be made. 

It appears from the researches of Mr. Webster in his 
laborious collection of facts on this subject, that, for 480 
years before the Christian Era, the scanty records of 
those times give an account of thirteen comets only, 
and eleven of them coincide with periods of mortal sick- 
ness. 

From the begiuning of the Christian Era to a. d. 1799^ 
the time of the author's writing, one hundred and twen- 
ty-eight comets are noted ; and it so falls out, that the 
principal part of these are attended with earthquakes 
and pestilential diseases of one kind or another, in some 
part of the world. 

History is deficient in not noting all the comets, and 
also in not recording the circumstances attending all of 
them ; as whether they were such as passed the nearest to 
this earth, which were attended with the greatest disor- 
der of the elements, and as connected with the most sick- 
ness ; but there appears to be an astonishing coincidence 
of sickness, earthquakes, severe storms, &c. attending 
the periods of cometic approximation. It is not to be 
understood, that these effects are most conspicuous at 
the very time that the comet is most visible, or in its 
perihelion, but often some months, or a whole year, 
before and after its actual and visible appearance. For 
a comet that takes perhaps a century to run its course, 
this time may not be considered unreasonable for its 
effects to be manifested. 



108 CAUSES OF FEVER. CHAP. III. 

" All the comets, that have approached this earth, in 
their passage to and from the sun, especially those that 
have passed very near us, have heen preceded, attended, 
and followed, by most extraordinary effects ; as great 
heat and drought in summer, and cold in winter ; delug- 
ing rains, violent tempests, and unusual tides. These we 
may consider as the constant and certain attendants on 
comets. They occur so uniformly with the appearance 
of those bodies, and for some mouths precediug and fol- 
lowing, as to leave no room to question the influence, 
from whence they proceed." 

" These remarks are justified by our own observa- 
tions. They were remarkably verified in the comet, the 
meteor, and brilliant halo, which marked the commence- 
ment of the last series of epidemics in 1788 and 1789. 
Riverius is express to the same point. He asserts that 
comets never appear without being followed by epidemics 
and pestilential diseases, and various changes in the 
physical world. He instances that of 1618, in his own 
days. The observation is verified by the testimony of all 
ancient, and by a uniform series of modern facts." 

" The order of events is exemplified in the epidemic 
periods of 1769 and of 1782. In the first period, exces- 
sive drought, during the approach of the comet in 1769 — 
failure of crops, famine, plague, and insects, in 1770 — 
Volcanoes, earthquakes, and tempests in 1770 and 1771 — 
Catarrh and measles in 1772, then for several years, 
angina, putrid fevers and dysentery." 

M In the period of 1781 and 2, catarrh began the epi- 
demics. In 1782 an universal failure of water and crops 
in India and Egypt ; — in 1783, volcano, famine, measles, 



SECT. III. CAUSES OE EEVER. 109 

angina, and plague — in 178 i, a comet, followed by tem- 
pests, kc/' 

The above is taken from Mr. Webster's second volume. 
To do justice to the subject would take more time, than 
is allotted to this part of the subject. For a further 
review of this subject, reference may be had to his first 
volume up to the year 1799. 

Two comets have appeared since the commencement 
of the present century. It is very much regretted, that 
a more perfect record of the phenomena of their approxi- 
mation is not at hand. This part of our duty has hither- 
to been neglected, but it is hoped they are preserved by 
some faithful historian. A few circumstances only can 
be mentioned here. 

In October 1807 a comet appeared, not, however, of the 
largest apparent size. 

The summers of this and of the preceding year, were 
colder than common. This has been imputed by some 
to the total eclipse of the sun, which happened on the 
16th of June, 1806 ; but may, with much more propriety, 
be imputed to the derangements made in our atmosphere 
by the approximation of the comet, which came to our 
perception the year after. 

In 1807, the 14th of December, an extraordinary me- 
teoric stone fell, at "Weston, in the state of Connecticut. 
The explosion of this stone in the air, and as seen by its 
light above the clouds, a little before day light in the 
morning, was compared to the report of cannon. Three 
reports or explosions were heard, attended with flashes 
of light and scintillations. The fragments fell several 
miles distant, making different sounds in passing the air, 



110 CAUSES OF FEVER. CHAP. III. 

and striking the ground. The phenomenon was asto- 
nishing to the beholders. One part of the stone, which 
fell upon another stone, and was fractured, was adjudged 
to weigh 200 pounds ! — another 35 ; — another 25, and so 
on to the smallest fragments. See the report of Messrs. 
Silliman and Kingsly, Med. Repository, Hexade 2, vol. 
5th, for a more particular account of this interesting 
phenomenon. 

In April, 1808, about six months after the first ap- 
pearance of the comet, meteoric stones fell in Italy; 
and in October following, in France, incrusted with 
ice ! 

In 1807, April preceding the comet, the spotted fever 
first appeared in this country, in Connecticut.* Fevers 
of different characters were prevalent in different parts 
of the country. In September, spotted fever at Deerfield, 
New Hampshire. 

In August, 1807, about two months previous to the 
appearance of the comet, the United States of America 
were assailed with the severest and most universal influ- 
enza ever known in this country. It extended from 
Georgia and the Mississippi to Canada. It was heard 
of in England and France. It assumed in some cases 
a pneumonic affection ; and in the latter part of its con- 
tinuance, after cold weather commenced, it was called 
pleurisy* 

In 1811, in autumn, about four years after the last, 
appeared another very brilliant comet. 

The summers of 1809 and '10, were uncommonly cold. 
Spotted fever prevailed, in some places, in 1809, and 

* A short appearance at Medfield, Mass. in 1806. 



SECT. III. CAUSES OF EEVEK. Ill 

more frequently in 1810, particularly in Massachusetts; 
and in the winter of 1810-11, in Vermont, &c. 

In July, 1811, about three months before the comet 
became visible, rains were excessive. The greatest 
floods ever experienced in this country. The rains con- 
tinued a considerable part of the month ; it sometimes, 
particularly on the 22d, fell in torrents. It is said, 
White river rose four feet perpendicular, in less than 
half an hour. Queeche river about the same. Great 
damage was done by the flood, in the destruction of 
bridges, mills, and some live stock. The greatest fall 
seemed to be near the centre of the state, upon the 
mountains ; the water ran in rivulets where none is ac- 
customed to run. About twelve miles north of this, in 
Stockbridge, the rain fell so heavy upon the top of a high 
and dry mountain, adjacent to White river, that it form- 
ed a channel from the top of the mountain, and took in 
its course trees, stones, and earth, down the whole steep 
of about three fourths of a mile across the turnpike, and 
formed an island in the river. This I have often seen, 
and it may be seen at this time. The effects on the west 
side of the mountain, were equally extraordinary in the 
neighbourhood of Otter creek. Mote damage was done 
there in property, than on the eastern course. Large 
tracts of meadow land ruined by being covered with 
earth and stones, &c. The circumstance of the sum- 
mers of 1809 and '10, being 1° 75 colder than the pre- 
ceding, should be kept in view, as stated by president 
Fitch. 

The spotted fever raged with its greatest violence in 
Vermont, in Canada, and the adjacent states, about six 



112 CAUSES OF FEVER. CHAP. III. 

or eight months previous to the appearance of this comet. 
It again raged in the winter following, being that of 
1811-12, principally in such places, as were most exempt 
the year before. 

The winter following, being that of 1812-13, was re- 
markable for two circumstances. One is the fatal and 
wide spreading epidemic peripneumony, which is in the 
remembrance of all ; and the other is the numerous 
earthquakes in the southern states. Tremendous earth- 
quake at Venezuela, March, 1812. 

Whether there may be any connection between the 
approximation of comets, and pestilential diseases, this 
is certain, that the period of general and mortal sickness 
in the United States of America, has substantially and 
very correctly coincided with the approximation of these 
two comets; and the quantity of sickness, in the two 
periods, has been about in proportion to the visual mag- 
nitude of the comets, and the length of time they were 
visible. 

We do not admit a mysterious and unconnected agency 
in these operations; it is highly probable that these 
changes are brought about by the usual operations of 
natural cause and effect. The approach of comets and 
other heavenly bodies, produces a change in the attrac- 
tive powers, and other principles, which serve as con- 
necting mediums between the respective bodies. It is 
presumable, that the electric fluid is a principal agent in 
all these phenomena. It may be considered as the most 
widely diffused, and universal principle in nature, capable 
of producing the most astonishing operations, and with 
the greatest rapidity. If there is any universal principle 



>ECT. III. CAUSES OF FEVER. 113 

in nature* it must be this. In its different habits of 
existence, it exhibits different phenomena. In the va- 
pour of the clouds, it produces lightnings and thunder, 
and all the majestic phenomena attending these sublime, 
aerial exhibitions. In the polar regions, it shows its 
presence in the wide spreading luminous sheets of the 
aurora borealis. It is the efficient cause of devastating 
tornadoes, as well as deep convulsive earthquakes ; and 
luminous appearances in our atmosphere. 

Possessing a facility of changing its habits of existence, 
and uniting with other subtle gaseous principles, it be- 
comes the source or prime agent of light and caloric, 
giving activity to all material substances on the surface 
of the earth. It points the mariner in the gloom of night 
through the trackless ocean by a peculiar fixed habit of 
existence in the magnetic needle. A new habit of exis- 
tence has lately been discovered, which has made philo- 
sophy acknowledge her ignorance of some of the differ- 
ent compounds of this pliant principle of nature — the 
galvanic fluid. 

This particularly shows an affinity, and near relation- 
ship to that principle, which is the active agent in 
living animal fibres ; and here, if further speculations 
might be indulged, would be suggested the idea of what 
is called nervous fluid, nervous influence, &c. being a 
peculiar habit of existence of the electric fluid, suited to 
the peculiar circumstances of animal texture, producing 
irritability and motion. Many of the phenomena of liv- 
ing animals in health and disease seem to warrant such a 
conclusion, With respect to the body, the celerity of all 
the delicate and compound motions, discover much ana- 

15 



Li* CAUSES OF FEVER. CHAP. III. 

logy (o this very active fluid. In disease, this nimble 
vivifying agent is disturbed in its regular course. Actual 
shocks are experienced ; disease invades like a stroke ; 
convulsions of some or all the functions ensue ; life is 
destroyed ; or the vital medium is restored, constituting 
health. # 

But speculation has led us beyond our design. Let us 
return for a moment from descanting on this mote of 
creation, man, to the great operations of the all pervad- 
ing principle — electricity, in the vast region of the pla- 
netary system. Let us behold there the order and har- 
mony, which prevails, by the agency of this active ener- 
getic fluid, acting steadily by laws, given it by the great 

* The spontaneous decomposition of animal bodies cannot 
be accounted for on any other principle than that of a sur- 
charge of electron. Many instances are on record, where peo- 
ple have been found not only dead, but burned to a coal, or 
oily cinder : and under circumstances, which could not be 
imputed to any operation of common fire. See Tytler on 
Plague, &c. where various instances are noted. Also Med. 
Rep. He*. 1. Vol. v. p. 460. Also the same volume, where an 
instance happened at Washington, in which Mr. Dayton's silk 
stockings, &c. were found burned to tinder in the night by his 
bed side. 

Many other instances of a like nature might be noted. 
Add to this the fact, that it is common for people in usual 
health, or at least, with a slight indisposition, to experience 
shocks in the head, very similar to that of electricity. 

This property in living animal bodies, has received the name 
of animal magnetism by Mesmer, and after him Puysegur ; 
and is most conspicuous in disease. The facts and experiments 
relative to this extraordinary property in animal bodies are 
too weighty to be denied with much assurance. Is not this 
same property put in exercise in the astonishing, and well 
proved operation of serpents charming birds ? 



SECT. III. CAUSES OF FEVER. 115 

First Cause. It seems to be the vinculum, or connecting 
medium, of the fragments of universal nature. By the 
powers of attraction and repulsion, which this fluid pos- 
sesses, pre-eminently above all others, the planets arc 
kept in their orbits, and perform their revolutions ; even 
the comets are called from their distant wanderings, 
to revisit the sun, and become visible to the inhabitants 
of our earth. A constant circulation of this fluid is kept 
up between the different planets, not strictly uniform. 
In some states and conditions there is a plus, and in some 
others, a minus proportion of this fluid: and this unequal 
balance may be considered to be the very exciting cause 
of all the stupendous operations of all the apparently 
preturnatural phenomena, which are discoverable in the 
natural world. 

From a disproportion of this fluid, and a greater collec- 
tion of it in the clouds, ascending from the earth, in the 
form of exhalation by heat, these are overcharged in 
proportion to the earth. The consequence is an explo^ 
sion from the clouds to the earth to restore the equili- 
brium. This is effected according to the known laws 
attending the motion of this fluid. 

Again, the earth becomes overcharged in certain cir- 
cumstances of our atmosphere, unfavourable to the elimi- 
nation of this fluid ; it vents itself by earthquakes, erup- 
tions from volcanoes, mephitic vapour, &c. 

These great operations of this very elastic fluid, have 
an effect upon the atmosphere, which seems to be the 
great highway of its movements. It appears to be the 
immediate cause of hail, tornadoes, meteors, &c. 

The combinations of this fluid are only in part known 
to us ; we have much reason to believe, that it is capa- 



116 CAUSES OF FEVER. CHAP. Ill 

ble of a great variety of combinations, and its different 
habits of existence, and connection with some of the other 
gaseous principles, in and around our earth, may produce 
an etherial fluid of a particular kind, unfriendly to the 
health of animal, and even vegetable bodies. This is 
offered as conjecture ; it will only help to extend our 
minds to notice the extreme tenuity and activity of those 
gaseous principles, that may be blended with the air, in 
which we move, and affect our bodies, by what has been 
denominated, by some of the greatest physicians of for- 
mer times, f* occult qualities." 

It will not be contended, whether an actually new pro- 
duct is added to our atmosphere, or whether a change of 
attractive and repulsive powers, has caused a different 
state of combination in the constituent principles of our 
atmosphere. It will chiefly be insisted, that a change 
has taken place, constituting what has been termed " a 
pestilential state of the atmosphere ;" and that, this state 
of air is brought about by changes, produced by the con- 
junction and opposition of the planets, through the medi- 
um of that permanently elastic, and non-gravitating fluid, 
electricity. 

These sentiments are advanced with a considerable de- 
gree of confidence 5 and it might be expected, that they 
ought to be connected with more evidence to substantiate 
them. 

This attempt, in order to be explicit, would lead us 
far beyond the limits assigned to this part of our sub- 
ject. It is hoped, that a spirit of free inquiry, and can- 
dour, will be exercised by all investigators of these sub- 
jects, " to discern the times and seasons, and see if these 
things are so." 



siliCT. III. CAVSKS OF NGYER. 117 

They load to the most important conclusions in medi- 
cal theory and practice* It will, however, be observed 
in general terms, as proof of these observations; first, 
that a great part of the hypotheses advanced, are strict- 
ly consonant to philosophical principles, supported by 
the authority of the greatest adepts in the science. 

Secondly, (lie reality of the immediate influence of the 
planets, especially comets, is warranted by fact, in this, 
that great changes are observed in our atmosphere and 
earth at their perihelions, or approximation to the sun; 
and that these approximations are not only attended with 
universal drought, storms, winds, meteors, &e. in the at- 
mosphere, but also with unusual earthquakes, and volca- 
nic eruptions from the earth ; and a pestilential state of 
the atmosphere, producing much mortality in the animal 
creation, in co-operation with the conjunct, or local cau- 
ses, to be mentioned hereafter. — See Webster's Collec- 
tions, also, Diembroke, Sydenham, Seneca, Van Helmont, 
Van Sivieten, Boyle, Mead, &e. 

Thirdly, the opinions of the ancients are entitled to 
some respect. Their reasonings were not, by any means, 
satisfactory, often involved in mystery and superstition ; 
notwithstanding, they were great observers of facts and 
uncommon occurrences. They bestowed particular at- 
tention on astronomy, and the effects of the heavenly 
bodies upon this earth and its inhabitants. They seem 
generally to impute the origin of epidemic diseases to 
planetary influence. Possibly the moderns may err as 
much as they, in too much neglecting these influences, 
and even ridiculing them. 

It may be considered that planetary influence, previ- 
ously noticed, is of a widely diffused nature, extending 



118 CAUSES OF FEVEK. CHAP. III. 

over great portions of the globe, and perhaps the whole 
of it. The cause is common to the whole earth, but is 
restricted, partially, so far as relates to the pestilen- 
tial influence being ushered in, through the medium of 
an earthquake, or volcanic eruption. Even in this 
case, it commonly only gives a very general pestilential 
influence along with the extensive and wide-spreading 
causes, which co-operate in their production. These 
planetary and terrene influences, are to be considered as 
giving to our atmosphere that property or pestilential 
condition, which has been denominated " occult quali- 
ties; 99 giving a predisposition or aptitude to disease. 
This state of our atmosphere must be considered to ex- 
ist, at all times, in a greater or less degree. It is per- 
manent, not affected by heat or cold, dryness or mois- 
ture, winds, or any thing else that we know of, unless by 
a cause as extensive and energetic as that which pro- 
duces it. 

And here it must be understood, that the foregoing 
assignable planetary influences only serve to augment 
the power of these occult qualities, or pestilential condi- 
tion ', and furthermore, that this general state, or pesti- 
lential condition of the air would seldom, if ever, pro- 
duce disease in man, unconnected with the numerous 
local or conjunct causes : and that these, the general and 
local causes, exert their hurtful operations on the bodies 
of mankind when brought into action by some exciting 
cause. 



SECT. IV. CAUSES OY ¥BVER. 119 

SECTION IV. 

Local or conjunct Causes. 

A proper attention to, and understanding of the ope- 
ration of these several causes, will explain many cir- 
cumstances, relative to the laws of epidemic diseases, 
which have perplexed physicians in all ages. Our atten- 
tion must first be turned to a consideration of what are 
denominated local or conjunct causes. 

The local causes of epidemic diseases are very nume- 
rous. No part of the earth is free from them in one 
shape or another. What makes the difference of health 
and disease, in different places on the surface of the 
globe, may be considered, in a great measure, to be a 
freedom from, or more exposedness to, the local causes, 
which will be considered under the character of miasma- 
ta and mephitis. 

Miasmata, as before defined, are the production of cor- 
rupting materials on or near the surface of the earth, 
whether vegetable or animal. It is not our design to 
enumerate all the varieties of local causes, but only to 
point out some of them, and pursue the connection of our 
theory. 

They may originate from animal putrefaction or de- 
composition ; hence we hear of the bodies of men in 
sieges, and on other occasions of great dearth, producing 
some epidemic disease. Instances of this kind might be 
multiplied. Large bodies of fish have been said to pro- 
duce fevers by corrupting and giving a deleterious quali- 
ty to the surrounding atmosphere. The same has been 



120 CAUSES OF FEVER. CHAP. III. 

said of insects, &c. In short, all kinds of animal sub- 
stances, in a state of slow or rapid decomposition, afford 
a noxious gas, that under all circumstances, predisposes 
the body to disease, and, under certain circumstances of 
excitation, actually induce it. 

The excretions of the human body, particularly the 
matter of perspiration, when suffered to be retained in 
the clothing, bedding, or other absorbing bodies, and 
subjected to a certain degree of heat, about 96°, are a 
fertile source of miasmatic productions. This kind of 
hurtful principle is generated in jails, hospitals, work- 
houses, ships, &c. where cleanliness and ventilation are 
neglected. 

A heterogeneous mixture of animal and vegetable sub- 
stances, subjected to fermentation by the heat of the 
sun, with only a small degree of moisture, is thought to 
produce miasmata of peculiar virulence. This kind is 
produced in large cities, about the wharves and streets in 
the warm season of the year. 

The putrefaction of vegetable substaaces, lying on the 
surface of the earth, in certain degrees of heat and mois- 
ture, affords this hurtful principle in abundance, and of 
a peculiar character. Perhaps there is always some 
portion of animal matter blended' with these ; such as 
reptiles, insects, &e. which may increase its virulence. 
This is often found in warm seasons, in low, stagnant 
waters and partially drained ground, as marshes, ponds, 
savannas, &c. 

Perhaps no part of the world is exempted from some 
productions of the miasmata, where animal and vegeta- 
ble substances are decaying, connected with heat and 



SECT. IT. CAUSES OF FEVER. 121 

moisture. It will be understood, that these productions, 
cateris paribus, are found most commonly, and in greatest 
abundance, in warm climates. It may be useless to be 
more particular on this at present, or to produce any 
authorities to substantiate the facts, relative to the pro- 
duction of miasmata. 

A more difficult task is now assigned us ; and, hitherto 
an almost unbeaten track to pursue ; in assigning mephi- 
tis, or a deleterious principle issuing from the earth, as 
a conjunct cause of epidemic fevers. 

The subject is rendered particularly difficult, on ac- 
count of the invisibility of the object of discussion; its 
sudden and transient progress, and, being blended with 
the common atmosphere, is dissipated, and often only 
discovered by its effects, and what we can learn by nega- 
tive evidence. It is, however, confidently believed, that 
enough is known of this enemy to the health of man to 
warrant the existence of such vapours, and their delete- 
rious effects. 

Mephitic exhalations are sometimes produced in abun- 
dance by the great terrestrial convulsions which take 
place in earthquakes. They will be considered as having 
local origin, and issuing from particular caverns near the 
surface of the earth ; and also from the surface of the 
earth in a silent vapour, damp, or exhalation. 

According to Mead, mephitis comes from a Syriae 
word which signifies « to blow, or breathe." He men- 
tions several places where these gaseous productions 
issue from the earth constantly, and, as reported by other 
writers, such as Cicero, Galen, Strabo, and others ; and 

IS 



122 CAUSES OE FEVEU. «HAI\ III. 

then gives a description of the poisonous vapour of the 
famous grotto, Del Cani, in Italy, known to every body. 

Similar facts are noticed by a variety of writers, as 
happening in different countries and places, such as 
46 mines, pits, and other subterraneous places. They are 
sometimes met with on the surface of the earth.' 5 Mead, 

According to Chaptal, it is found at the well of Perols, 
near Montpelier ; in that of Negrae in Vivarais $ on the 
surface of several hot-springs, and on the surface of the 
lake Averno, in Italy. Birds that fly over this lake drop 
down dead. All the before mentioned exhalations are 
suddenly destructive to animal life, when sufficiently 
concentrated. It is very probable that the mephitic 
vapour of our wells, which is so frequently fatal to those 
who enter them, issues from the earth. Some facts war- 
rant the conclusion that they are suddenly produced. 

It may be objected, perhaps, that these vapours are 
nothing but fixed air, or carbonic acid gas, and that it 
does not mix much with atmospheric air, but keeps near 
the earth, &c. This may all be granted ; but they show 
that noxious exhalations may issue from the earth, even 
possessing a greater specific gravity than air, and this 
gives ground for a strong presumption, that vapour of 
greater tenuity may come from the earth, and blend with 
the air, hurtful to its salutary qualities, and that they 
may be conveyed to a great distance. 

The history of meteoric stones warrants a conclusion, 
that even mineral particles may be elevated from the 
earth, in the evaporation of water from its surface. 
Perhaps these mineral particles of great tenuity, are 
assisted in their ascent by an electric magnetic in- 



tBCT. IV. CAUSES OF FEVER. 123 

flnenee, accompanying the process of evaporation ; and 
when elevated to a certain distance, forty or eighty miles, 
are disengaged from their guides, unite hy an elective 
at I motion to particles of a similar nature, and at length, 
fall to the earth by their specific gravity of different de- 
grees of density. They have been noticed in various 
parts of the world, and unquestionably a few only have 
been found of the great number that may be supposed to 
have fallen in different ages, and in unfrequented places. 
Some are small and have been found incrusted over with 
ice or hail; others larger, as the one which burst over 
Connecticut, in 1807. 

Chymical analysis has demonstrated, that these stones 
coutain different substances, such as flint, iron, nickel, 
sulphur, magnesia, calcareous earth, &c. These pheno- 
mena are noticed to enlarge the mind, to help us to con- 
ceive, that if these ponderous bodies can be raised in the 
atmosphere, vapours of a deleterious quality, and more 
volatile, may find a ready ascent and suspension in the air. 

The hydrogenous gas is common even in this country, 
issuing from certain springs, and taking fire when ignited, 
and keeping up a perpetual blaze. 

It is not the visible vapours or exhalations, that have, in 
various periods, been discovered to arise from the earth, 
and produce diseases, which we consider as the most im- 
portant and deleterious ; yet some of these will be men- 
tioned. But it is a silent and invisible vapour, that may- 
be presumed to arise along with the exhalation of water, 
and perhaps elimination of electricity from the earth, 
which, at certain times, when the general morbid influ- 
ence prevails in the air, shows its hurtful effects in pre* 
disposing the body to disease. 



12* CAUSES OF FEVER. CHAP. III. 

" Iu autumn, 1753, after a dry season, arose in Rouen, 
the chief city of Normandy, a thick fog with the smell 
of sulphur, which increased to that degree, that in the 
evening, lights could not be distinguished at any conside- 
rable distance. It did not wholly disappear till the next 
day. It was more dense in some streets than in others. 

In three or four days after, began an epidemic sick- 
ness, which seized both sexes with chills, lassitude, loss 
of appetite, slight pains iu the arms and legs. These 
symptoms were followed by bilious looseness, nausea, 
and vomitings. Most of the sick bled at the nose fre- 
quently in small quantity. The headache then became 
violent, with a small hard pulse — a high fever followed. 
The region of the stomach and hypochondria were tume- 
fied ; this symptom was succeeded by a tension of the bel- 
ly, and a slight delirium followed. The tongue was brown 
or black, but moist ; sometimes with green ulcers or 
aphthae. The patient died on the 5lh, 7th, or 11th day ; 
but not in every case. Some were thirty or forty days 
in recovery ; many were left with a puffiness of the face, 
hands, and legs. 

In some other parts of France appeared peripneumony 
and inflammation of the pericardium, which was called a 
new disease." Phil. Trans, vol. xlix. 

Forestus relates, that an epidemic sore throat in Ale- 
mar, in 1557, suddenly invaded 2000 persons, of whom 
200 died. He ascribes it to a vapour, for the disease 
was preceded by thick clouds of an ill smell. See Van 
Swieten, vol. xvi. 

" Mazery relates that the black pestilence, in 1S47, 
arose in China from a vapour, which burst from the 



SECT. IV. CAUSES OF FEVER. 125 

earth, with a smell most horribly offensive.'' This fact 
is cited by Boyle, vol. v. in proof that pestilential dis- 
eases spring from vapours, evolved from the earth. 
This author supposes, that new diseases may be gene- 
rated by vapours. A disease raged in many places 
about this period; and it was estimated that one half or 
two-thirds of the human family perished in about eight 
years."* 

Seneca relates that a vapour in Campania, caused by 
an earthquake, destroyed 600 sheep. Eruptions of vol- 
canoes have been preceded many weeks by a visible fog 
or vapour suspended over the mountains, as happened 
before the great discharge of Heckla, in 1783. If a 
sensible vapour can be extricated from the earth, why 
may we not suppose an insensible vapour may be also 
extricated ? 

It is asserted by historians, that earthquakes have 
been preceded by a perturbation, a discolouration, and 
even stench in the water of wells and springs. The 
most reasonable explanation of the death offish, at cer- 
tain seasons, especially in epidemic seasons, is, that it is 
effected by a deleterious vapour, extricated from the 
earth, contaminating the water, and rendering it unfit 
to sustain animal life. 

A hurtful vapour, supposed to contain an acid, was 
extricated from the earth by a bursting of fire in Ice- 
land, according to the account of Mr. Holm. Hail and 

* " In London, 50,000 were buried in one grave-yard. In 
Norwich, England, died about the same number; in Venice, 
100,000; in Lubec, 90,000; Spain lost two-thirds of its 
inhabitants; and in Asia, 20,000.000 !'' Webster's Coll. 



126 CAUSES OF FEVEK. GUAP. III. 

rain followed of so corrosive a quality as to destroy men 
and cattle. The effects were felt as far as Norway. 

From the numerous facts, serving to prove that nox- 
ious vapours arise from the earth, a few only will be 
uoticcd. One, much in point, mentioned by Dr. Priest- 
ley; taken from the history of the formation of an 
island in the Archipelago, in 1707, during a volcano. 
"The sea of the gulph in which it was formed, from 
being of a bright green, assumed a red colour ; after- 
wards it was of a pale yellow, and it was accompanied 
by a great stench, which affected the island of Santorin, 
at the distauee of several miles, in such a manner, that 
the inhabitants were seized with acute pains in the head, 
and violent vomiting. The vapour blackened silver and 
copper." 

In various periods, a sort of corrosive property is ma- 
nifested to exist in the air by the circumstance that 
metals are apt to rust ; vegetables are blighted, &c. It is 
very probable that an acid is predominant ; Dr. Mitch- 
ell considers it the septic acid ; but it is not the present 
design to particularize. 

Numerous instances might be adduced to illustrate 
the fact, that visible or demonstrable vapours do some- 
times arise from the earth and mix with the common 
air, causing it to he less suitable to sustain animal life. 
It is probable, and indeed it is philosophical to suppose, 
that there is almost constantly arising from the earth 
exhalations of great subtlety, which serve to render 
the air less fit to sustain the regular functions of the 
animal economy. 



SECT. IT. CAUSES OF FEVEIt. 127 

" Unusual darkness broods ; and growing, gains 

The full possession of the sky, surcharg'd 

With wrathful vapour, from the secret beds, 

Where sleep the mineral generations, drawn. 

Thence nitre, sulphur, and the fiery spume 

Of fat bitumen, steaming on the day, 

With various tinctured trains of latent flame, 

Pollute the skg." Thomso.v. 

APPLICATION. 

We shall now endeavour to make a more particular 
application of the foregoing facts and reasoning. It be- 
ing granted that a general state of atmosphere prevails 
at one time different from that at other times, and that 
this is very extensive, and is brought about by very re- 
mote and general causes, constituting what has been 
denominated by physicians a pestilential or inflammatory 
constitution of the atmosphere ; we shall signify that it 
is very doubtful whether this of itself, is ever sufficient 
to induce disease without the presence of local or con- 
junct causes ; and also that the local causes seldom pro- 
duce diseases, without the concurrence of the general 
pestilential cause. 

The general cause may be considered as always pre- 
sent in some degree ; hence sporadic cases of disease 
are here and there met with. But in certain other 
conditions it is manifestly more abundant; and it is this 
high state of existence that the local causes, by a kind 
of co-operation with this, discover their alarming influ- 
ence in the production of diseases. 

When the general cause is absent, the local causes 
may be considered as harmless ; for they continue near- 



128 CAUSES 0* FEVER. CHAP. 111. 

lv the same in different places and seasons, without the 
prevalence of disease, unless aided by the general cause. 
Hence the miasmata of the streets and docks of cities, 
and also that of prisons, &c. become obnoxious only in 
certain seasons, and in such seasons as manifest a gene- 
ral morbid constitution of the atmosphere, by a preva- 
lence of sickness in different places, exposed to different 
local causes. 

It is, therefore, agreeable to the history of those dis- 
eases called epidemic, that when one prevails in a certain 
place, the same or some other generally prevails in ano- 
ther place : and these are diversified according to their 
several local causes ; and also if the local causes are ab- 
sent, the people of that place are exempt from sickness. 
Numerous facts throughout the world, and especially in 
America, will serve to substantiate these positions. 

It has been noted by writers of the history of diseases, 
that there are sickly periods, when the inhabitants of a 
great extent of country, and perhaps the whole world, 
will be assailed with mortal sickness. This sickness is 
usually of different kinds: in some places, plague, — in 
others, yellow fever, — in others, intermitting or remit- 
ting fevers, — in others, dysentery, typhus, &e. 

All these diversified states of disease depend upon the 
difference, that may be supposed to exist in the local 
causes. It is beyond the present discriminating know- 
ledge of man to point out in what this diversity consists, 
as respects the identity of the several local causes: — but 
this we are confident of, that there is considerable 
diversity in the several local causes. They have differ- 
ent origins as proved before, and exhibit different grades 



SECT. IV. CAUSES OF FEVER. 129 

and localities of disease. When the general atmosphe- 
ric cause is present, a slight local cause may form a 
strong predisposition to febrile commotion. It is ob- 
servable, that at such times, chronic diseases are more 
obstinate, and more certainly fatal. Slight injuries, 
such as wounds, bruises, burns, &c. are apt to be more 
troublesome, than in a healthy state of the atmosphere. 
And again, if such accidents happen to a person, when 
both the general and local causes are present, he is 
almost certain to have the prevailing epidemic. In this 
instance, they act as exciting causes to be noticed here- 
after. 

This pestilential state of air is so manifest when it 
prevails in any region, that it is a common observation 
among all practitioners, that it gives a sort of character 
to chronic diseases, and predominates in other acute 
diseases in such a manner as if compelling them to 
assume its characteristic symptoms. 

It has been heretofore a matter of astonishment to 
those, who hold to the contagiousness of epidemic fe- 
vers, that their favourite contagion should be confined 
to their own villages ; and various subterfuge arguments 
Lave been resorted to in order to make good the proposi- 
tion ; — whereas by looking at the true and rational 
proofs of the origin of these different kinds of diseases, 
we see their laws unfolded in a just and proveable man- 
ner, to the satisfaction of the true seeker after medical 
science. 

If, instead of scrutinizing old shoes, rags, &c. to find 
imported fomites, and accusing foreigners of transport- 
ing epidemic diseases, the zealous inquirers after truth 

17 



130 CAUSES OF FEVER. CHAP. III. 

had exerted their talents to discriminate and render 
innoxious the local causes of diseases, the science of 
physic would have become less reproachful to its culti- 
vators. 

If a person has resided in a place exempt from any 
particular local cause, although not exempt from the 
general cause, and now should migrate to a place con- 
taminated with a local cause, he will be more likely to 
receive the impression of disease, than one that has 
always resided there, on account of the change being 
sudden and great. It is a law of the animal economy, 
that the system will bear preternatural changes and 
impressions to a surprising degree, without essential 
injury, provided the impressions be applied very gradu- 
ally.* Hence it is that the natives of any place are not 

* Since writing the above, the instance of Mr. Morley in 
England, as published in the public prints, appears to be in 
point. Mr. Morley, his wife, and three children, removed to 
a house, that had been tenanted, until two days before, by a 
family for twelve years, without any inconvenience. The day 
after they entered the house, in the afternoon, the doors were 
broken open by the neighbours, who found the whole family 
in bed, in an insensible condition, and the oldest child dead. 
The father, the mother, aod the next oldest child lived a day 
or two and died, the youngest only survived. 

Upon examination of a jury, it appeared that u a great 
quantity of rubbish from potter's ovens, consisting of cinders, 
corks, old moulds, &c. had been thrown together adjoin- 
ing the house, and new coals from the oven repeatedly thrown 
on them, kept the whole in a state of fermentation, although 
now covered with snow. From these was extricated a "nox- 
ious vapour," which penetrated the walls of the house, when 
the wind favoured it. Lights were extinguished in the cellar, 
and very quickly if held near the wall. 



SECT. IV. CAUSES OF FEVER. 151 

so liable to epidemic diseases as strangers who visit 
those places. The exceptions to this proposition arc 
but few; when such exceptions do happen, they may be 
explained upon the principle of peculiarity of suscepti- 
bility meeting with a peculiarity of local cause. 

A ship coming into a harbour from a long cruise with 
miasmatic effluvia on board is precisely the same, as for 
a stranger to visit a city, containing the same thing. 
The city is supposed to be free from miasmata, but the 
ship giving a miasmatic atmosphere, makes a strong 
impression upon those, who have not been accustomed 
to it ,• and the consequence is, that the inhabitants of the 
city, who go on board, suffer ten to one, perhaps, to 
what the crew suffer. 

Again, if prisoners be brought from a close and filthy 
confinement of long duration, where their bodies and 
clothing are highly contaminated with miasmata, before 
strangers, who have been accustomed to a pure state of 
air, and perhaps in a close and crowded room, as hap- 
pened at Oxford, in 1557, the miasmatic effluvia may 
have a powerful and dangerous impression upon those 
strangers ; whilst the prisoners will escape, from a very 
gradual and habitual application of the cause which is 
sufficient to excite disease in others. 

Various instances of a similar nature might be 
brought. All these facts have served to mislead the 
contagionists; they insist that these facts prove conta- 

It will be noticed, that the materials had lain here a long 
time, but the former family received no injury in consequence 
of a gradual impression. 



132 CAUSES OF FEVER. CHAP. III. 

gion ; when in fact, those who are so unfortunate as to 
suffer in this way, never communicate the disease! — 
The suddenness of the impression sometimes acts as an 
exciting cause. See Sect. 6. of this Chap, 

A fact must here he kept in mind, that it is under 
certain circumstances only, that these local causes pro- 
duce such alarming effects ; namely, where the general 
morbid state of the atmosphere prevails. For the want 
of this discrimination much confusion has arisen. It is 
common for corrupting materials to cover the streets of 
cities ; it is common for filthy ships to arrive in ports; 
it is common for long confined filthy prisoners to be 
brought before magistrates ; — it is common for the coun- 
try to be interspersed with mill-ponds and standing pools 
of water ; — it is frequently the case that thousands of 
carcases of men and beasts putrefy on the surface of 
the earth; and all this without producing any disease 
among the people. But it must be noted, that these 
exemptions take place in the absence of the general 
morbid constitution of the atmosphere; and also at the 
very time, that the inhabitants of the earth are most 
free from other epidemic diseases. 

Upon a review of these facts, it seems demonstrable, 
that in order to produce epidemic diseases, it is necessa- 
ry that the general and local causes should both be pre- 
sent. This position, unquestionably, holds good, as it 
respects all those epidemics that depend on a local 
miasmatic cause. 

But the matter appears a little more doubtful, as it 
respects those diseases, that have been strictly deno- 
minated pandemic, or affecting a great extent of country 



SECT. IV. CAUSES OE EEVEK. 133 

suddenly, and at the same time. The influenza is the most 
conspicuous example of this. To this perhaps may be 
added the severe peripueumonic fever in Vermont and 
the adjacent states in Che winter of 1813; — as also many 
other diseases, which have prevailed in different coun- 
tries in different periods. 

If there are any diseases, that depend wholly upon a 
geueral cause in the atmosphere, it would appear that 
the influenza was one of these. Our limited compre- 
hension of the great operations of nature, forbid that we 
should rashly decide on a question of such magnitude. 
It is well ascertained, however, that influenza generally 
precedes diseases of greater magnitude ; and it is often 
the first harbinger to warn us of approaching danger. 
Although the more important diseases, which are to fol- 
low, do not succeed for several months or a year after, 
they are pretty sure of coming in the course of the sick- 
ly period, which commonly lasts two or three years. 

This circumstance discovers the influenza to be strong- 
ly connected with the general pestilential constitution of 
the air, and as depending upon a change in the atmosphere ; 
but as it is transient, and is discontinued, whilst the same 
general constitution prevails, and also, as it seems to 
be progressive as to place, although pretty rapid; we 
are induced to assign it a conjunct cause. What this 
may be, cannot be asserted with any confidence; but, 
for the present, we shall suppose it to be gas of 
some kind or other. It cannot be assigned to any of the 
super-terrene miasmata, as their influence is never 
known to extend to any considerable distance. We 
are therefore forced to look for it among the sub- 



13* CAUSES OF FEVER. CHAP. III. 

terrene exhalations. It will appear from the previous 
notices of this kind of hurtful influence, that they are 
more permanent and extensive than the miasmata, and 
may be considered as more diffusive and durable.— Per- 
haps the earth is frequently emitting from its bowels a 
silent vapour through water, the surface of the earth, 
and in time of frost, through various crannies and chan- 
nels, and mixing with the common air. These may be, 
for the most part, harmless, unless when connected with 
the general pestilential diathesis. 

The same observations may be applied to the other 
diseases, that extend very widely, especially in the 
winter season. The greatest sticklers for contagion can 
hardly presume to assign this as a cause ; and as nature 
is generally uniform in cardinal principles, though great- 
ly diversified in particulars, we are induced for the pre- 
sent, to believe that they have a conjunct cause, and that 
this must be a vapour or exhalation from the earth, sud- 
denly emitted, perhaps in a very distant part. 

The influenza seems not to be produced by cold, 
though it is easily excited by it ; as it often appears in 
tropical countries; it also appears in this country in 
the midst of summer. A very remarkable instance of 
this happened in August, 1807, which invaded very sud- 
denly the state of Vermont, although it seemed to pro- 
gress moderately from south to north. It is generally 
the herald of other diseases, and denotes insalubrity in 
the atmosphere. 

The air we breathe to-day may have been respired but 
a short time before by a Hottentot or a Peruvian; or 
might contain the poisonous vapour of Hecla or Vesu- 



SECT. V. CAUSES OF FEVER. 15b 

vius, wafted hither by the great currents that are known 
to traverse our atmosphere. But sources of contamina- 
tion may he nearer home. 



SECTION V. 

Predisposition, or a greater liability to disease as an effect 
of remote influences. 

The foregoing may be considered as remote causes ; 
having an insensible effect upon the systems of men, 
whereby they are rendered liable to disease. 

This state of the human body has been denominated 
a predisposition to disease ; but we are not here to under- 
stand it as being actual disease; but only a susceptibility 
or aptitude to particular diseased action in the system, 
when thrown into any state of commotion by the exciting 
causes, which are very numerous. 

It may be a very curious question to determine, what 
actual change takes place in the system, that should ren- 
der it so liable to the attack of fever from slight causes, 
which would not be noticed at another time. 

The very delicate functions of the human system, as 
connected with nervous irritability, are intricate and 
difficult to be understood ; and more especially to be ex- 
pressed, from the poverty of language. In these parti- 
culars, physiology acknowledges its ignorance. 

From what we can discover, the remote causes exert 
their first influence on the numerous nervous expansions, 
distributed on the surface of the body ; in the lungs ; in 
the throat; in the alimentary canal; in fine, upon all 
the internal membranes, blood-vessels, and muscles. 



136 CAUSES OF FEVER. CHAP. III. 

The subtle aura, like the electric fluid, may be consi- 
dered as pervading the whole system, and giving a new 
tone to the nervous energy. A peculiar morbid exci- 
tation, or vacillating tone, seems to be manifested by 
a greater liability in the system to be disturbed upon 
slight impulses. Abortions are frequent at such peri- 
ods. Small scratches are liable to inflame ; and chro- 
nic diseases are rendered more obstinate. Old sores 
grow worse, and old scars, and calluses of the bones, 
suffer slight pains. The healthy physiognomy and usual 
degree of strength in mankind in general is diminished ; 
and it may be left to the casuist to determine, whether 
the different passions of mankind are not more readily 
excited ?* 

The predisponent influences seem to have the effect of 
inducing less energy in the system, with a greater de- 
gree of susceptibility of action from slight impressions. 
Further, those organs of the body, in a healthy state, 
which perform what are called involuntary functions, 
such as the heart and arteries in particular, have a 
greater permanency of nervous energy imparted to 
them, than the organs of voluntary motion; such as the 
muscles of loco-motion, extremities, &c. 

From hence all impressions of debility of the nervous 
system at large exhibit different effects in different parts 
of the body, according to the different degrees of per- 
manent nervous energy, imparted to each particular 

* The reader may, if he pleases, consider the circumstance 
of the internal feuds, and war of all Christendom being at 
their zenith in 1811 and 1812, &c. Also the series of na- 
tional turmoil since 1807, 



SECT. V. CAUSES OF FEVER. 137 

function ;— from which position, it is easy to apprehend 
that those organs or parts of the body, possessing the 
least permanent nervous energy, suffer most from an 
abstraction. Take, foe instance, the state of sleep, 
which is a slate of temporary debility. The voluntary 
muscles become quiescent, whilst the motions of the 
heart and of the organs of respiration continue, with 
some diminution only in frequency. Less energy of ac- 
tion is discoverable on the surface of the body and extre- 
mities in sleep than in wakefulness, with the same 
covering and condition of personal atmosphere. 

All the secretions in the remote capillaries, may be 
considered as less in the time of diminished energy of 
sleep, other things being equal ; even perspiration not 
excepted. 

The intricacy of the subject has induced this illustra- 
tion, to give an example of the tendency of every diminu- 
tion of the energy of the system, depending on a general 
operation, to have its greatest effect on parts least en- 
dowed with nervous energy. In the instance of syncope, 
energy first fails in the skin, the extremities, the vo- 
luntary muscles, then in the heart; but this last organ 
soon feels the renovating influence of nervous energy, 
and the equilibrium is restored. 

There is no difficulty in conceiving, that powers gra- 
dually applied to the system, may induce a change in 
the tension and irritability of the muscular fibre, causing 
the state of health to vary a few degrees from the most 
perfect healthy standard, and yet not induce actual dis- 
ease ; and even to be unheeded by the subject. Instances 

18 



13S CAUSES OF FEVER. «HAP. III. 

of this are very familiar in common life, from adventi- 
tious causes. 

One circumstance further of some importance maybe 
noted here, and numerous facts might he quoted to sub- 
stantiate the position, that people in a state of despon- 
dency, of fear, of despair, of disappointment, or chagrin, 
are more liable to he attacked with epidemic fever, than 
they are in opposite circumstances. The passions of 
the mind variously affect the body ; the depressing 
passions weaken the exercise of the functions, and invite 
disease. 

It may be understood, that the general hurtful powers 
in the atmosphere affect all people within their influence ; 
but not in the same degree. This is supposed to arise 
from the different constitutional liability or aptitude to 
impressions from external objects. This may be notic- 
ed in the mind as well as the body. Hence we find 
valetudinarians possessing oftentimes this irritability of 
fibre in the most exquisite degree, are the first affected 
in an epidemic season. This state of predisposition is 
manifested in epidemic seasons by vertigo, slight pains 
in the head, and nervous debility, in moveable habits. 

A view of the acquired state of susceptibility may be 
understood by observing how readily tooth-ache, ear- 
ache, tic-douloureux, &e. may be excited by even the 
slightest impressions of cold, or other causes, where the 
predisposition is present ; which at another time would 
not be noticed. 

Hitherto the hurtful predisponent principle has been 
considered entire, and without any discrimination or 
notice of varieties. Ail that will be observed in this 



SECT. V. CAUSES OF EEVER. 139 

place is, that it consists of many varieties ; as is demon 
strable from the effects produced. But to ascertain (he 
specific condition of the hurtful principle, is above the 
present state of philosophy. 

The influenza is marked by a local affection of the 
throat and lungs; the dysentery, by an impression 
somewhat similar, as appears by dissection, in the lower 
intestines ; — the angina, or canker rash, affects principal- 
ly the throat ; — the yellow fever principally the biliary 
organs aud stomach ; — and the plague the inguinal and 
axillary glands. 

From a knowledge of these facts, we are irresistably 
led to the conclusion, that there is a specific difference 
in the predisponent principle* And further, it appears 
true, almost to demonstration, that so far as we are 
acquainted with local causes, these serve to give the 
specific difference ; and where we are not acquainted 
with them, as in influenza, epidemic pleurisy, &c. we 
may presume them to make the difference, 

How far a real substance may be applied in these 
instances, is difficult to determine ; but some impression 
seems to have been made upon particular organs in all 
these instances, more than upon other organs. We 
know that articles of the Materia Medica have a ten- 
dency to excite into action different organs in a differ- 
ent manner. 

People may talk about sympathy from foreign ob- 
jects; but this is difficult to be understood, otherwise 
than through the medium of the passions. A material 
rather seems necessary to have an effect, however at- 
tenuated it may be. The smell of a rose, which some- 



140 CAUSES OF FEVER. CHAP. III. 

times produces fainting, associates the idea of matter 
impinging the olfactory nerves. 

A more satisfactory illustration seems to be given by 
these facts, that mercury placed upon the shelf of a fire- 
place, in an open vessel, will produce salivation in those, 
who occupy the room, after some weeks; also, that 
those, who are exposed to the vapour of lead, are liable 
after some time, to a particular kind of colic. 

Many similar circumstances might be brought, but 
we must be cautious of analogical reasoning ; it only 
serves to help the mind to comprehend difficult subjects. 
It is not very probable, that the predisponent influences 
are so permanent as in the instances of the mercury and 
lead; — indeed it is questionable whether they would, in 
these instances, produce disease without the aid of ex- 
citing causes. Perhaps the subject of specific impres- 
sions may hereafter be further noticed. 

Let us now suppose a person enveloped in an atmos- 
phere capable of changing the tone in a peculiar manner, 
and consequently the state of the system, from the usual 
standard of health, and approximating it to febrile 
action, and observe the necessary consequences. It does 
not appear to be a necessary consequence in this case, 
that the subject should certainly be affected with fever ; 
and we actually find, that many pass through the most 
severe epidemic seasons without being affected. 

It is not only probable, but certain, that much may be 
done to prevent the access of fever. On the other hand, 
the circumstances that impel the system to diseased 
action, are numerous ; and this leads to a consideration 
of what may be called exciting causes. 



SECT. VI. CAUSES OF FEVER. 141 

SECTION VI. 

Exciting Causes, fyc. 

Under this head may be noticed all those powers 
which casually affect the mind or body sufficiently to 
produce any kind of commotion in the actions of the 
system. Such causes, as, in a state of sound health, free 
from any predisposition, would be unheeded and harm- 
less, in this peculiar vacillating and irritable state of 
the system, produce great oppression and disturbance. 

It may not be necessary in this place to designate all 
the exciting causes. This might be attended with much 
difficulty and labour. Let the mind turn upon the varied 
scenes of life, and observe the different pursuits and 
unstable habits of mankind ; the different changes in the 
atmosphere, as respects heat and cold, dryness and mois- 
ture, &e. the different passions of the mind, influencing 
the corporeal part ; and we discover that these may be 
multiplied to a great extent. 

Cold, or the abstraction of caloric, will be considered 
as the most frequently pernicious of the exciting causes. 
It is not the absolute degree of cold, that is to be dread- 
ed, but the relative; and as it respects the suddenness 
of the transition. Winter and summer have but little 
effect in the production of epidemic fevers. Their par- 
ticular character may be changed, but they spread at 
all seasons, especially in those attended with the most 
sudden vicissitudes. Thus the changes may be in the 
atmosphere; the temperature of the body being the 



14& CAUSES OF FEVER. CHAP. III. 

same ; or it may be from the body's being heated, and 
returning to the ordinary state of air ; and again, the 
body may be exposed to the usual temperature of the 
air, but under circumstances not well suited 10 resist the 
impression of cold, as happens in the state of sleep. A 
great proportion of the most violent eases of epidemic 
diseases, happens from attacks during the night. 

In whatever manner cold is applied, it evidently ope- 
rates by diminishing energy in the action of the system ; 
and whatever stimulant effects may appear, ought to be 
referred to the collision in the system ; and, in a par- 
ticular manner, the action of the heart and arteries. 

The natural vigour of the healthy system seems to be 
kept up, by a dispensation of animal caloric to all the 
remotest parts, through the medium of the circulation 
of the blood. It will only be necessary to observe, in 
this place, that it seems to be the property of cold to 
give permanency to the changes induced on the surface, 
in the capillary arteries, lymphatics, &c. through ner- 
vous stricture, or tonic spasm. This permanency of 
torpor in capillaries, perpetuates febrile commotion; 
and this circumstance renders it probable, that cold has 
a concurrent operation with all the other exciting causes. 

If the circulation languishes, as in debility it must* 
the surface and capillaries are robbed of their natural 
share of stimulus. Admitting that nervous energy is 
previously diminished ; it is manifest that the applica- 
tion of cold will still more increase the diminution. The 
effect is scantiness of blood, of caloric, &c. with paleness, 
shivering, &c. But of this more particularly hereafter. 

Certain facts have been related by different writers, of 
people being suddenly affected with faintness, followed 



SECT. VI. CAUSES OF FEVER. 143 

by distress and fever, upon receiving offensive and op- 
pressive scents, &c. at certain times. Such impressions 
have been considered the efficient and sole cause of the 
fever ; and it is said, that it is contagious, and acts by a 
ierineniing principle, &c. It may he replied to this; — 
that these impressions so offensive to the olfactory 
nerves, and through these and the lungs, communicating 
to the whole system, only show these deleterious effects 
in certain seasons, and under certain circumstances; to 
wit, when all the other elementary causes concur to pro- 
duce sickness. The offensive impressions are very com- 
mon in life, but it is only at such times as epidemic dis- 
eases ace spreading, or beginning to spread from their real 
causes, that accidents of this kind happen. It will there- 
fore be considered, that offensive impressions upon the 
olfactory nerves act as exciting causes by the commotion 
they produce in a highly predisposed subject. It is alto- 
gether immaterial iu what manner the system is thrown 
from its pivot, or even balance of healthy action ; whether 
by passions of the mind, by lesions of the body, or inju- 
ries through the medium of the senses. It is sufficient 
that commotion is induced, and the system thrown into 
inordinate action ; and we see that this last continues, 
like the pain of a defective tooth, until the paroxysm is 
over, notwithstanding the exciting cause is passed by. 

Fear, grief, anxiety, fatigue, watching, wounds, 
bruises, burns, surfeiting, famine, all passions in excess, 
intoxication, debauchery, &c. may all be placed amongst 
the most prominent of the exciting causes; — or those cir- 
cumstances, that excite or disturb the regular functions of 
the system, and consequently induce febrile commotion. 



144 CAUSES OF FEVER. CHAP. III. 

That some of the fore mentioned exciting causes are 
necessary to the production of epidemic fever of all kinds, 
is rendered sufficiently probable from this circumstance, 
that the sick can most commonly refer to some time and 
place, when they were under the influence of them ; and 
that their disease began directly, or in a very short time 
from such exposure. It may be noticed, that neither 
they, nor their friends, are always capable of discrimi- 
nating so correctly ; but this is no proof, that the causes 
have not had an impression, for a very little deviation in 
an exquisitely excitable state of the system, is sufficient 
to induce disease. Many receive this impression in the 
unguarded hour of sleep, who went to bed well. They 
awake in distress ; or perhaps they will arise with but 
little indisposition ; but a few hours will warn them of 
their danger. 

Changes of weather happen oftener than people change 
their bed-clothes; hence it is common for writers to 
mention great numbers being taken with dysentery or 
some other epidemic, in one night, particularly after a 
shower ; perhaps more than have been attacked for ten 
days before. Something like this we have witnessed in 
dysentery, and other habits of epidemic complaints ; more 
particularly in influenza, and peripneumonia epidemica ; 
these being diseases attended with local affection in such 
parts (throat and lungs) as cool air always finds access to. 
Beside this, as it respects influenza, this seems to be a 
disease giving a peculiar susceptibility to impressions 
from cold, and a desire to avoid it; hence it is so readily 
excited. 

One circumstance further deserves to be mentioned as 
proof that exciting causes are of importance; more espe- 



SECT. VI. CAUSES OF FEVER. 145 

eially as the fact has generally been improperly explain- 
ed ; which is, that in time of plague, those that shut 
themselves up in their houses ami do not go out, are not 
very apt to have the disease. The same has been ob- 
served of nuns ; also the same of prisoners. The same 
has been said of alms-houses, hospitals, and indeed of 
work-shops, &c. 

Facts of this kind have been noticed by American 
writers upon yellow fever, &c. The solution of all the 
difficulty seems to consist in this, that these characters, 
from their insulated situation, are not so much exposed 
to the exciting causes. In certain instances, however, 
they may not be so much exposed to the local causes. 

Praphylaetic Rules. 

The praphylaetic rules to be observed in all epidemics 
may be comprised in a few propositions. 

i. The general predisponent cause cannot be avoided. 

ii. When the local cause is known, it ought to be re- 
moved. If this is impracticable, it should be avoided by 
removal out of the deleterious atmosphere, which is com- 
monly but a few miles distant. 

in. If this cannot be done, use diligence to obviate the 
effects of predisposition. 

1st. The effects of predisposition may be rendered less 
dangerous by carefully noting the state of action in the 
system. 

If any degree of pain or restlessness is discovered 
with quickness of pulse, 

1st. Take blood. 

19 



lit) CAUSES OF FEVEK. CHAP. 111. 

2. Make use of saline laxatives. 

3. Promote perspiraiion in the gentlest manner. 

4. Use vegetable food and diluent drinks. 

a. Avoid stimulants. 

If the pulse is slow and vacillating, 

1. Use small doses of carbonate of iron or Peruvian 
bark. 

2. Use wine very moderately. 

3. Gentle laxatives of cream of tartar and rhubarb. 

b. Promote external warmth and perspiration. 

5. Observe equanimity of mind ; and, 

6. In both instances keep the tone of the fibres as near 
the healthy standard as possible; observing, however, 
that the force of the heart and arteries be rather dimi- 
nished, than increased above the natural standard. 

iv. Avoid exciting causes. 

1. A knowledge of the before mentioned exciting cau- 
ses will be sufficient for avoiding them. 

2. Use moderation in all things. 

3. Be diligent to keep the body in an even temperature, 
moderately warm. 



CHAPTER IV. 

CONCERNING FEVER IN GENERAL; 

SECTION I. 

Definition of Fever. 

The symptoms of fever are all equivocal. Whatever 
definition of fever may be made, its character must, at 
present, be considered as ambiguous. It is from an as- 
semblage of circumstances attending the particular state 
of violence or rapidity of diseased action in the system, 
that forces upon the mind a discrimination between those 
diseases that are more quick, and those that are more 
slow, in their operation, and consequently in their ter- 
mination. 

Those states of disease, attended with most violent 
action, have been called acute; those attended with 
more slow and torpid action, with long continuance, have 
been called chronic. The acute diseases have not been 
well defined ; some are only of seven days' continuance, 
perhaps ; whilst others are of as many weeks, or even 
more. Indeed, our views are extended, when we consi- 
der, that certain diseased states of the system destroy 
life in four hours ; such as plague, yellow fever, spotted 
fever, &c. and others, under bad management, have the 
same effect after an hundred and twenty days, as typhus 
fever, &c. 



148 PHENOMENA OF FEVER. CHAP. IV. 

The symptoms in general are very similar in the acute 
and chronic states of disease ; making allowance for the 
different force of morbid impressions, which may be 
called the causes of disease, and the different irritabili- 
ties of the subjects, and some other circumstances of a 
personal nature. 

It is observable, that both these divisions of disease 
are generally attended with local affections. They are 
attended with more or less commotion in the pulse ; with 
more or less cold shivering ; with some increase of heat ; 
with the interruption and disorder of several functions.* 

From this view of the subject, we are led to observe a 
very strong analogy between fevers, and the more pro- 
tracted diseases, called chronic ; and the difference,which 
we discover in the more violent, or more mild concourse 
of symptoms, may all be apprehended; partly from the 
particular condition of the subject, and partly from the 
degree of violence in the nocent cause. Take, for ex- 
ample, pneumonia and pulmonary consumption. In the 
former, the attack is rapid, and the disease quickly de- 
structive, from, perhaps, a connected disordered action 
of a great portion of the system; and which is concen- 
trated in the lungs, producing a violent concourse of 
symptoms. In the case of pulmonary consumption, we 
discover the same concourse of symptoms, only more 
mild ; yet equally fatal if not obviated. Both cases are 
attended with cold chills, heat, pain, cough, expecto- 
ration, ulceration, emaciation, &c. In the latter case, 
the causes are not so hurtful, or make less change in the 
functions of the system, and of course, the responding 
action of the system is more mild and protracted. 
* Cullen. 



SECT. II. PHENOMENA OF FEVER. 1*9 

Cases of hydrocephalus have terminated fatally, in 48 
hours; in other instances, three years have hardly been 
sufficient to free the wretched sufferer from his cruel 
disease. 

Rheumatism, and many other affections, might be ad- 
duced to show, that the symptoms are very similar in the 
acute and chronic state of disease ; and that the diffe- 
rence consists altogether in the degree of violence offer- 
ed, and the responding action of the system. 

In acute disease, the danger is most prominent, and 
most to be dreaded from a general operation in the sys- 
tem, destroying life, perhaps, before any essential organ 
is spoiled. In chronic diseases, the greatest danger is 
apprehended from the spoiling of some essential organ ; 
and the effect of this is more to be dreaded, than the 
violence of general diseased action. 

From these considerations, it appears very difficult to 
give a definition of fever, otherwise than as an assem- 
blage of symptoms and circumstances denoting a more 
violent state of action, and a more suddenly fatal 
tendency, than those which attend chronic diseases* 

SECTION II. 

Phenomena of Fever, in connection zcith its proximate cause.* 

Our review of the phenomena of epidemic fevers, in 
common, may be short. They will be considered, as 
connected with the proximate cause, so far as that may 
be understood. The causes predisponent and exciting, 

* By proximate cause may be understood the first preterna- 
tural change made in the system by hurtful impressions. 



150 PHENOMENA OF FEVER. CHAP. IV. 

mentioned in the last chapter, having been applied, the 
first symptoms are a sense of weariness, lassitude, faint- 
ness, and desire for rest and sleep ; which all denote a 
torpor, or want of nervous energy in the system. The 
muscles of voluntary motion are deficient in power. The 
heart at this moment heats more feebly and more slowly. 
These circumstances warrant the opinion, that the first 
change in the system is a weaker action of all its parts> 
through defect of nervous energy. If the previous state 
of predisposition had shown signs of excitement, yet, 
upon the application of exciting causes, a degree of tor- 
por is induced in all the functions of the system. The 
application of cold, under certain circumstances, as in 
Chap. in. Sect. 6, may be supposed the most pernicious 
of the exciting causes ; indeed, it evidently appears, that 
this concurring with the previous state of predisposition 
and collateral exciting causes, gives a degree of perma- 
nency of torpor in the capillaries, difficult to be over- 
come. It is supposed to have some similarity of opera- 
tion in the lymphatics and capillary arteries, that tonie 
spasm has in the muscles.* 

* Torpor added to increased susceptibility, is often attend- 
ed with fixed spasm. A person slightly indisposed is liable to 
have cramp in the leg upon moving it into a cold place in the 
bed. Cold induces the torpor, and, in moveable states of the 
system, spasm follows; the function being impaired, may be 
said to be in a state of debility. With respect to capillary 
vessels, it may be suggested, that after spasm is removed, an 
inability and imperviousness sometimes remains; this again 
may be called debility or torpor. Fevers often commencing 
with convulsions of the whole muscular system, and ending in 
tetatnus, corroborate these positions. See Chap, V. Sect. 2, 



SECT. II. PHENOMENA OF FEVER. 151 

Let us suppose, fop the present, that torpor continues to 
increase, which is actually, sometimes, the fact, in those 
diseases that have been called malignant, such as plague, 
spotted fever, &c. and which terminate in a few hours in 
death. The consequence is, that there will he an un- 
common paleness in the countenance, coldness in the 
extremities and on the surface of the body, perceptible 
to a by-stander, but not felt by the patient himself; a 
shrivelling in the veins under the skin, and the Wood in 
them, giving the appearance of a darker hue through 
the skin, rendered more transparent by a receding of 
blood from the smaller capillary vessels. Sometimes 
a stagnation of blood in capillary vessels of the skin, 
gives a dark sublived appearance. The blood suffers a 
change of colour, from the want of a due degree of 
oxygenation, on account of the torpor of circulation in 
the veins, and impaired function of the lungs. Blood 
is drawn with difficulty, at this time, and can seldom 
be made to run a stream, but trickles down the arm of a 
darkened colour. 

At the same time, there is much distress and anxiety 
in the precordia from a collection of blood, in the great 
vessels, more than the enfeebled heart can circulate. 
Synchronous with these phenomena will be a stupor or 
imbecility of intellect, from an accumulation of blood in 
the larger vessels in the unyielding bony case of the 
head ; operating by compressing the brain, and increas- 
ing the danger by still more weakening nervous energy, 
which needs to be distributed to the remote fibres and 
vessels. The distress increases in every internal part, 
but is not distinctly realized by the semi-apoplectic pa- 



152 PHENOMENA OF FEVER. CHAP. IV. 

tient ; it is, however, often manifested by irregular 
groans and broken sighs; also by hasty and abrupt 
expressions, together with unmeaning and deviating 
motions. 

Very early in this stage of things, the heart attempts 
to exercise its pre-eminence over the organs of voluntary 
motion, and over the subordinate series of inferior ves* 
sels, by efforts to relieve itself from its massy load. The 
first efforts are irregular ; the stimulus to exertion is 
great ; not having capacity to propel its usual quantity 
at a pulsation, it quickens its pace to make up the defi- 
ciency. All is ineffectual. The balance of strength is 
against it, in consequence of the derangement in the ex- 
ercise of the functions of the capillary system. Comato- 
delirium, with aberrations of mind, and much solicitude, 
are often present, from irritation in the encephalon. The 
heart palpitates with much vehemence ; — 140 or 170 pul- 
sations may be distinguished in a minute; and after that, 
a more tremulous motion. The pulsations shortly cease 
at the wrist; coldness increases on the surface and extre- 
mities, with convulsive puking ; the eyes become suffused 
with trickling tears, and lose their brilliancy; a slight 
sub-lived shade beneath the cuticle; respiration is short 
and hurried, interrupted by sighs and groans ; the heart, 
although possessing the most permanent vigour of any 
organ in the body, has to resign its umpire ; it ceases 
from the exercise of its office, and with it, respiration, 
which is now only a gasping ; and our patient, with a 
flaccid countenance, isfolded in the calm repose of death !* 

* This is what every practitioner must witness, who is con- 
versant with the more violent kinds of epidemic diseases. The 



SECT. II. PHENOMENA OF FEVER. 153 

Kr verting back (o our order of proceeding, it will 
appear, that a torpor in (he action of the system, is in- 
duced, attended with stricture of the surface, and weak- 
ness in the voluntary muscles; paleness of countenance ; 
receding of blood into the larger internal vessels, with 
coldness, not perceptible to the patient in the last recited 
instance; but the most common effect is, that the heart 
and arteries, do propel the blood into the finest blood- 
vessels in the muscles and on the skin, with a flush in 
the countenance, restoring animal warmth to the impo- 
verished surface, and thereby giving the sensation of 
heat and cold, commonly called cold chills. These 
vary in degree in different cases. They are favourable, 
as they denote the external vessels permeable in part, 
and that the torpor may be overcome by the exercise of 
the heart and arteries, and that the system may be saved 
from the danger of destruction. 

The co-operation of hurtful powers, which excite dis- 
ease, may be said to have a temporary debilitating effect 
on the system. It is an invariable law of the animal 
economy, when any power is applied, producing a tempo- 
rary debility or depression in the living irritable fibre, 
that energy or action rises above the natural standard, 
as soon as it is relieved from the debilitating impres- 

pictureis intended in more general terms to apply to the more 
suddenly fatal cases of spotted fever, but it is believed, will 
apply to all the more alarming epidemics. All this scene is 
acted, sometimes in the short space of two hours; often in four, 
twelve, or twenty-four hours. It is common in the country, 
where we have to ride a few miles only, to find our patient 
dead before our arrival ; and perhaps another taken sick. 

20 



lb* PHENOMENA OF FEVER. CHAP. IV. 

sions. This responding action constitutes fever or py- 
rexia. If the depressing powers are great and sudden, 
life may be extinguished without this responding action, 
or only in a small degree. If they are more slight, and 
the system has opportunity, and not incumbered with 
too great impediments, responding action is often strong 
and permanent, producing what may be called morbid 
excitement, or fever. The degree of morbid excitement 
is varied by numerous adventitious and personal circum- 
stances. 

One common effect is, that the blood accumulates in 
too great quantity in some organ essential to life. Pain 
follows, often excruciating. The pressure of blood indu- 
ces a stretching of vessels ; their irritable coats act with 
their own elasticity in large vessels, and with musculari- 
ty in small ones ; and often in a spasmodic manner. The 
circulation is pressed on one side, and hindered on the 
other ; inflammation ensues. The serous vessels, distri- 
buted on the surfaces of blood-vessels of more capacity, 
and the serous vessels of the surfaces of organs, in mem- 
branes, &c. become injected with red blood ; constituting 
the error loci of some writers. This is of much impor- 
tance in pathology ; it takes place oftentimes, and per- 
haps constantly in one place or another, in all fevers, in 
some part or other of the internal membranes. Its pre- 
sence is oftentimes distinguishable by pain, and some 
degree of heat and soreness. 

If the primary cause of fever is overcome by the 
natural operation of the system, or by the help of art, 
this wandering blood quits its unwelcome abode, by a 
retrogade motion ; if, however, the imperviousness or 



SECT. II. PHENOMENA OF FEVER. 15b 

stricture, continues, these vessels retain their pressure 
or congestion with memhrunous inflammation; and this, 
in its turn, serves to keep up an irritation in the whole 
system, and protract fever. 

This phenomenon is witnessed in a multiplicity of dis- 
sections. In the membranes of the brain, it produces 
pain, delirium, or coma; and perhaps serous effusions 
into the ventricles, constituting hydrocephalus. On ihe 
surface of the lungs and pleura, it produces pain, effusion 
of serum in the cavities, which may be absorbed again, 
and produce adhesion ; — in the bronchial vessels, it af- 
fords the fine blood, by a bursting of the thin coats, 
which is raised with the sputa; — in the stomach, it pro- 
duces more pain, from the delicacy of nervous irritability, 
with puking and a sensation of heat and inflammation . 
and, sometimes, affording a small portion of blood to the 
other materials, secreted from the internal coat, gives the 
colour of black vomit; in the membranes of the nose, 
the vessels may rupture and produce epistaxis ; in the 
colon and rectum, the terminations of small vessels rup- 
ture, producing the bloody mixture in dysentery; in 
the case of typhus fever, the accumulation of blood is 
great in the mesenteric vessels, and their intestinal ter- 
minations may be ruptured at innumerable points, pro- 
ducing a flow of blood, which terrifies the patient and 
physician, when it is only the kind hand of nature to do 
what the physician should have done, days or weeks 
before, with his lancet. Sometimes on the surfaces of 
the internal membranes, as also on the skin, this peculiar 
membranous affection has a sort of stellated appearance* 
giving the different varieties of petechia;. Dissections 



156 PHENOMENA OF FEVEK. CHAP. IV, 

exhibit this stellated appearance on the internal mem- 
branes of the colon and rectum in dysentery ; and on the 
surface of the lungs, pericardium, diaphragm, &c. in 
spotted fever ; as also on the external and internal coats 
of the stomach. Finally, if the general state of disease 
is not ameliorated, but continues, this superficial inflam- 
mation in certain places internally, is wont to commuui- 
cate to adjacent membranes, and to subjacent vessels, 
until a considerable extent is converted into a hard, firm, 
red substance, with a deposition of cougulable lymph in 
the interstices of fibres. The function of the part is im- 
paired or destroyed, and inflammation, more strictly 
phlegmonic ensues, with all it consequences. Or, by an 
effusion of coagulable lymph or other fluids on the sur- 
faces of membranes in different cavities, produces many 
phenomena in different organs, as the effect of diseased 
action ; as in croup and pneumonia. 

This pressure or congestion in the lungs, on account 
of their yielding texture, produces a constipation in the 
vessels, of disoxygenated blood, which sometimes proves 
suddenly fatal. 

SECTION III. 

Affections of the sympathetic nerves. 

From what was suggested in Chapter in. Section 5, 
it will appear agreeable to the laws of physiology, that 
the involuntary organs, called also by some, assimilating 
organs, by receiving the nervous influence through the 
agency of ganglions in the sympathetic nerves, have a 
more permanent influence on the organs to which they are 



SECT. III. PHENOMENA OF FEVER. 167 

distributed, than over other organs, which are supplied 
immediately from the encephalon. Hence it is that we 
discover great weakness in the external muscles of loco- 
motion, whilst the heart continues to act with much vi- 
gour. Whilst fever continues, it is to be expected, that 
the stricture on the surface, and internal inflammation, 
are not yet removed, even though there may be much 
heat present; and the heart and arteries will act, with more 
or less vehemence, until the stricture on the surface, and 
internal affection, are removed, and the capillaries become 
permeable ; — or until, it has exhausted itself of all its 
energy, by repeated and fruitless efforts, and falls into a 
state of eternal rest, after weeks of toil and labour; simi- 
lar to the instance before mentioned of a few hours. 

Were it not for this established order of things, there 
would be no conservative principle in the animal econo- 
my. Hurtful impressions on the muscular fibre of the 
surface, would be equally felt in the more vital parts, and 
man would be the prey of many vicissitudes which he now 
passes by, with seeming indifference. 

Upon this law of the animal economy, may be explain- 
ed a great proportion of the symptoms of fever. The 
heart is the last organ, that, ostensibly, ceases to act. 
This will continue in some conditions, when all the other 
functions are quiescent ; and if resuscitation takes place, 
this is the primum mobile. I have witnessed myself a few 
instances, where the pulse beat at the wrist, from one to 
two minutes, in people dying with spotted fever, after 
every other sign of life was absent, and have been assured 
of the same thing hy others. 

It is believed, that this takes place in vigorous habits, 
and where stimulants have been used, and after the cner- 



158 PHENOMENA OF FEVER. CHAP. IV. 

gy of the system has emerged, in some degree, from its 
first state of depression ; but where the fatal event takes 
place in this last mentioned condition, the pulsation at 
the wrist often fails for some lime before the heart ceases 
to beat. 

On account of the intimate union and intertexture of 
the numerous branches of the great sympathetic nerves 
so liberally bestowed upon the organs in the abdomen, in 
the thorax, and partially in the throat, we gain an under- 
standing of many phenomena in fevers which otherwise 
are unintelligible. When one organ is more particularly 
injured, the others suffer more or less, by a kind of simul- 
taneous action or sympathy. 

An injury done these nerves, as they are distributed in 
the viscera of cavities, whether by wound or inflamma- 
tion, produces vomiting, and the heart is forced into a 
violent action, being connected with the great family of 
the sympathetic nerves. Disease produced by some inju- 
ry done to organs supplied by these nerves, is of a pecu- 
liar nature. Extreme distress attends them, unless coma 
is present, from congestion in the head; the pulse is 
quick, hard, small, and oppressed ; a falling of the coun- 
tenance with cold sweats, &c. at the close. Inflammation, 
falling upon these organs, runs through all its stages 
much more rapidly, and with much more danger to life, 
than inflammation in the membranes and muscles in 
other parts of the body. The same set of mortal symp- 
toms, or indireet debility, for example, which takes place 
in fatal cases of rheumatic fever, at the end of three 
weeks, takes place in the iliac passion, at the end of 
three days. The same may be said of the gout, when at- 
tacking these viscera, instead of the extremities. 



SECT. IV. PHENOMENA OF FEVER. 159 

Now as it is provable beyond controversy, by dissec- 
tions, that, in certain epidemic fevers, some of these or- 
gans are manifestly injured more than others; so we find 
a particular set of symptoms attending each epidemic; 
and, at the same time, we find many symptoms in com- 
mon to them all. 

SECTION IV. 

Localities of disease. 

It may be ob^erv. d in this place, agreeably to what 
was suggested in Chapter in. Sect. 5, that there is a 
difference in the predisponent principle, whereby some 
one part of the body is rendered more liable to vascular 
and membranous inflammation than others; constituting 
the diversity of symptoms in different epidemics. An idea 
of this membranous affection may be gained by inspect- 
ing the adnata of the eye in a state of inflammation ; it; 
however, is not always so conspicuous. From the best 
evidence we have, it will be suggested, that a peculiarity 
in the local causes of disease, gives the different varieties. 
In the yellow fever, the locality of disease is principally 
situated in the region of the liver and stomach; hence 
from a particular affection of the branches of the vena 
porta, the disease is attended with bilious appearances. 
The bile is not the cause of the disease, but only an effect 
of perverted organic action. 

In spotted fever, it is very difficult to fix on any one 
particular organ, as its place of constant habitation. As 
the eruption upon the surface is sometimes universal ; so 
the affection of all the internal membranes, is sometimes 



160 PHENOMENA OF FEVER. CHAP. IV. 

discoverable. It might be called the mocking fever ; as 
it assumes the mask of most others occasionally. It 
most commonly fixes on the anterior and inferior mem- 
branes within the cranium ; it sometimes resides princi- 
pally in the stomach and contiguous parts : sometimes in 
the heart, lungs, &c. 

In angina scarlatina, or epidemica, the locality is very 
constantly in the throat ; but the membranes on the sur- 
face of the body, and also the membranes of the trachea, 
participate, and more particularly those within the head. 
In pneumonia epidemica, the locality is generally con- 
fined to some or all the membranes of the viscera of the 
thorax. 

In dysentery, the locality is almost altogether confined 
to the internal membrane of the rectum and colon. 

In typhus mitior, the hurtful agents are feeble and 
slow; — the local impression appears to be divided be- 
tween the membranes in the head and abdomen. 

In intermitting fever, the liver, stomach, and spleen, 
are more apt to suffer than any other internal viscera. 

In influenza, the locality is very generally in the tra- 
chea and internal membrane of the lungs. 

In puerperal fever, prevailing epidemically, the locali- 
ty is confined to the uterus and viscera of the hypogastric 
region. 

Notwithstanding, the foregoing phenomena usually ap- 
pear, as they are described, and these localities afford 
their discriminating characters, yet it is frequently the 
fact, that other organs suffer immeasurably in the con- 
flict of disease by contiguity, or by similarity of mem- 
branous continuance, or by nervous association \ — for 



SECT. \. PHENOMENA OB FEVER. 161 

example, i lie yellow fever, though principally in the sto- 
mach, is attended with much affection of the liver, and 
also of the head. 

SECTION V. 

Varied diseased action. 

Hitherto the before mentioned epidemic disease* 
have been considered, as prevailing altogether in a solita- 
ry manner ; indeed, it is usual for some one to have the 
pre-eminence; hut it is also frequent for two or more of 
them to prevail at the same time. By this may be un- 
derstood, that the epidemic causes, by meeting with per- 
sonal peculiarity, may affect different organs, and have 
different symptoms; aud consequently have different 
names attached to them ; also the diseases are supposed 
to be of very different diatheses, when it is only another 
variety of the same disease. 

It is common to see dysentery, and those fevers called 
bilious, prevailing at the same time; or it may be such, 
as are denominated typhus, &c. It is very frequently the 
fact, that when common fevers prevail of any kind, many 
will have the disease, which is called colic, or what many 
suppose to be colic, although the intestines are pervious. 

It is common for pleurisy, phrenitis, croup, typhus, 

and even mania, to prevail at the same time. Numerous 

remarks of a similar nature might be added of diseases 

prevailing at one and the same time, of supposed different 

diatheses, when in fact, it is nothing more than this, 

that the disease falls with greater force on some other- 

organ than usual. 

21 



16% PHENOMENA OF FEVEK. CHAP. IV. 

These facts are of infinite importance to the practi- 
tioner, and might be so to the nosologist. They teach 
the former that all epidemic diseases are of one family, 
and nearly allied to each other ; and that the principal 
difference consists in a difference of certain symptoms, 
which entirely depend upon the locality of the disease ; 
and however necessary it may be to bestow particular 
attention upon these, in certain varieties, yet the general 
state of diseased action is very similar, and to be relieved 
by the same general remedies. 

The nosologist may reflect on the danger of substitut- 
ing names for essences 5 and the folly of establishing 
fixed characters to the mutability of diseased action, 
not comporting with the physiognomy of the case at the 
bed-side of the patient. 

SECTION VI. 

Depraved action of the stomach, liver, and kidneys. 

Various other appearances are noticed to take place, 
and in different degrees, as a consequence of deranged 
actions in the system in the attack of fever,* many of 
which may be apprehended from the repercussion of 
humours from the surface to the internal viscera, which 
have become impatient of stimuli and distension from 
predisponent influences. See Chap. in. Sect. 5. 

The stomach essentially suffers not from bile, or viscid 
sordes, as is sometimes imagined, for these are the after 
consequences, but from the same vascular action and 
nervous sympathy, from which the other viscera suffer. 
Vomiting sometimes suddenly appears, and this denotes 



SECT. VI. PHENOMENA OF FEVER. 163 

the same kind of organic action that \vc discover in the 
kidneys, which is attended with a flow of urine ; and when 
the same action falls with most force on the intestines, 
diarrhea or dysentery may he the effect. 

The first impression on the stomach is denoted hy a 
sense of faintness, then sickness, then vomiting. All 
these effects are suddenly produced. The other visce- 
ra, perhaps, oftentimes feel the m or hid impression, as 
soon as the stomach ; but this, from greater sensibility, 
first manifests its convulsive throes to our perception, by 
a discharge of its contents. This effort is also often at- 
tended with salutary consequences ; for the action of 
vomiting helps diffuse the circulation from the centre to 
the circumference, which is answering the natural indi- 
cation of cure. By this effort the torpor, or tonic stric- 
ture, is sometimes overcome, and the circulation esta- 
blished in the lymphatics of the skin and subjacent parts, 
especially if the operation is in circumstances favourable 
to sweating. But the patient is not often so fortunate as 
this. The vomiting may continue without this beneficial 
effect ; and its repetition becomes a source of irritation 
to the coats of this viscus, attended with membranous 
inflammation. 

After the vomiting has been continued only a few repe- 
titions, the bile finds its way into the stomach through 
the common passage, and is thrown up with the other 
secretions. It is expected now to be secerned in greater 
quantity from the same general cause that induces a 
more violent action in the other viscera. Superficial 
observers in all ages have agreed to accuse this innocent 
straggler, as being the author of all the mischief. The 



164 PHENOMENA OF FEVER. CHAP. IV. 

mineral and vegetable kingdoms have been rifled of their 
most powerful engines to assail it ; and the conflict has 
often terminated in the loss of the patient, before the 
extermination of his supposed enemy. The bile also 
pursues its natural course down the duodenum, if not re- 
verted with excessive vomitings, and lodges more or less 
in the intestines; accumulating here and mixing with he- 
terogeneous matter of the intestines, assumes a darken- 
ed colour, and needs oftentimes suitable cathartics to dis- 
lodge it. If calomel is used for this purpose, the discharge 
will be more darkened.* 

* To prevent being misunderstood, it may be necessary to 
observe, that it will not be denied, but that the bile may offend 
in quantity and quality in certain instances. It manifestly 
does in certain states of fever of some continuance, when the 
circulation has been pressed into the mesenteric vessels and 
into the vena porta, which suffers from the circumstance of a 
torpor, passing a second circulation, without the vigorous 
impulse of the heart and arteries. The vena porta may -re- 
ceive more blood, and have internal congestion at such times, 
and possessing properties more appropriate for the formation 
of bile, and perhaps of a more irritating kind. For the 
purpose of dislodging this, gentle vomits may occasionally 
be interposed ; and not only for evacuating the secreted bile, 
but also for the purpose of exciting a motion in the hepatic 
system of vessels. For the same purpose cathartics may occa- 
sionally be employed. There is a wide difference in* having 
it in view to fulfil the above indications, and having it in 
view to unload the stomach, duodenum, liver, and gall bladder 
of bile, and considering this as the cause of disease. If truly 
it were the cause of disease, it should be evacuated, and then 
the disease may be supposed to cease, as might be expected 
from any other offending matter; but this is not the fact. 

It is further probable, that in certain places and seasons the 
predisponent causes may have a peculiar effect upon the hepa- 



IBOT. VII. PHKXOMEXA OF FEVER. 165 

The kidneys suffer in the conflict of febrile commo- 
tion. The repercussion of humours from the surface to 
the internal parts, throws an undue quantity of blood 
into these viscera; but in the beginning febrile action is 
not so vehement as to suppress the renal secretion. This 
is analogous to the skin, which will admit of sweating 
more freely on the first day of fever, than after much 
heat has arisen. Therefore, there is often a flow of 
limpid urine in the beginning of fever. After febrile 
heat has arisen, there is a scantiness of urine, and often 
attended with signs of strangury from much tenderness 
in the delicate membrane of the urethra. After an un- 
certain continuance of fever, if it terminates favourably, 
along with the relaxation and permeability of all the 
finer order of vessels, the venal glands prove their deli- 
verance by a discharge of gross fluids from the consti- 
pated vessels, and decomposed humours. 

SECTION VII. 

Depraved action of ike Skin. 

The skin exercises an important office in health and 
disease. In fever its function is depraved. The natu- 
ral function must be restored before the health is esta- 
blished. In the attack of fever, perspiration is sus- 

tic system, inducing peculiar biliary symptoms ; as takes place 
in yellow fever, &c. Let all this be conceded ; yet a wide 
difference arises in the mind and follows in the practice, upon 
considering that the vice is in the organ, and not in the con- 
tents of the organ ; and that our object should be to modify 
and regulate the former, and evacuate the latter, so far as may 
be conducive to that end. 



166 PHENOMENA OP PEVER. CHAP. IV. 

pended, with dryness and corrugation. This may be 
restored in the beginning by external warmth and mois- 
ture, and mild stimulants internally. The ease now 
partakes of the nature of direct debility. If the perspi- 
ration is not restored in the beginning, which is very 
necessary, for the purpose of conducting heat from the 
body, the heat accumulates in the centre, and is increas- 
ed afterwards on the surface ; and when in this condi- 
tion, perspiration and sweat cannot be induced until 
there is a subduction of excitement by blood-letting and 
other anti-spasmodic means, with external warmth, &c. 

SECTION VIII. 

Thirst. 

Along with the torpor, or inert action, or depraved 
action, in other parts of the lymphatic system, we dis- 
cover a drought or want of moisture in the exhalents of 
the mouth, fauces, oesophagus, and stomach, denominated 
thirst. Excite the capillary system into action, which 
is known to take place by the flowing of sweat, and 
thirst ceases. 

SECTION IX. 
Heat. 

Upon the access of fever, coldness, in a greater or 
less degree, is present. After an uncertain interval, if 
the subject is so fortunate as to survive the first im- 
pression, which is generally the case, much heat is expe- 
rienced in the system. This is different in different 



9ECT. X. 1'IIENOMENA OF FEVEK. 167 

subjects, and indeed indifferent habits of febrile disease. 
In some of the most alarming states of lever, the external 
heat is not very great, and perhaps the internal is not so 
abundant, as in some other states. In other eases the 
heat is very great. 

The heat seems to be conveyed by arterial circulation. 
The oxygenation of the blood, through the instrumen- 
tality of the lungs, is the general received opinion ; but 
where the lungs may be supposed in an impaired condi- 
tion, as actually takes place in pneumonia, doubts have 
arisen whether the oxygen is received in due quantity to 
produce the abundant heat. It is probable, that part of 
the heat may be produced by decomposition going on in 
the blood, and part from the agitation and collision of 
the vessels upon their contained fluids, acting by a kind 
of constrictive nervous energy; or does this last excite 
the electrical principle ? 

SECTION X. 

Spasms, convulsions, delirium, coma. 

The nervous system is materially connected, and inti- 
mately concerned in the phenomena of fevers ; as indi- 
cated from this circumstance, that it is a pretty frequent 
occurrence, that spasmodic jerks of the muscles are dis- 
covered in various parts of the body, on the first attack 
of fever ; — and further also, that from the distress of 
new and unpleasant sensations, convulsions often appear 
over the whole system. These are sometimes repeated; 
but most commonly one fit only is experienced ; and this 
may be one of the first symptoms of the attack. This 



168 PHENOMENA OF FEVER. CHAP. IV. 

symptom may be considered propitious, as it denotes a 
capability in the system to emerge from the first state 
of depression. In the after stages of fever, tetanus 
sometimes appears;* it is unpropitious, but not a fatal 
symptom. 

Delirium is two fold, attended with sleepiness, or at- 
tended with watchfulness. The first seems to be con- 
nected with congestion in the blood vessels of the brain 
with torpor; — the last, with congestion, and vascular 
excitement. They both demand serious attention. 

Another variety may be noticed, being a volatile deli- 
rium, attended with pleasantry, which seems to arise 
from a moderate excitement, without congestion ; or 
after congestion may have been removed by proper re- 
medies. This is generally allayed by applying cold sub- 
stances to the head. 

Congestion in the head without inflammation in that 
organ, is attended with coma, and weakness in the vo- 
luntary muscles. Congestion with inflammation is often 
attended with delirium, and much strength in the volun- 
tary muscles. This seems to denote a forced condition 
in the animal functions, and cannot be sustained beyond 
a certain degree, for any considerable length of time, 
like the action of the heart and other functions,which all 
depend on nervous influence for their ability of acting. 

* In certain states of predisposition in warm climates, 
tetanus is one of the first symptoms of fever. It is such a 
manifest and alarming symptom, that it has assumed the pre- 
dominant character of the disease, and has been frequently 
considered the principal disease, when it should be considered 
only a symptom of the primary affection. 



¥ECT. XI. PHENOMENA M EEVEK. 169 

After inflammation with delirium, has supervened 
upon congestion with coma ; this last may again appear 
in consequence of a secretion of pus, or lymph, from the 
membranes of the hrain, operating by eompression. 

Jt may be hinted in this place, that the suggestions of 
Professor Rush, are well founded, in considering the ac- 
tion of the sanguiferous system in fever as of a convulsive 
kind. 

SECTION XL 

Solids and fluids. 

Whether epidemic diseases act primarily upon the 
solids or fluids, has excited much speculation. It will be 
perceived, that no notice of their action upon the fluids 
has hitherto been taken, nor now only to put the ques- 
tion aside ; — yet it is manifest, that great changes do 
take place in the fluids as a consequence of diseased 
action. 

The fluids are entirely quiescent, and act only as they 
are aeted upon. A mild and salutary action is necessa- 
ry to their integration ; but to apply remedies to the 
fluids, with a view to restore their perfection, is like 
striking at the effect to remove the cause. 

Diluents and matters of suitable appetency, are neces- 
sary to the supply of proper nutriment ; — and again, ab- 
straction of blood and other fluids is, oftentimes, abso- 
lutely necessary to alter the tone of the vessels. 

The passions of the mind have sometimes induced 
fever; and again, fear and terror have sometimes re- 
moved it. This proves the proximate cause of fever to 
to exist in the solids. 



170 PHENOMENA OF FEVER. CHAP. IT. 

As soon as heat is generated, or becomes accumulated 
in the system upon the attack of fever, the blood appears 
to acquire a sort of expansive or rarefied state, actually 
occupying a larger space. The effects of this may be 
readily apprehended ; and in those states of fever con- 
nected with a very unequal distribution of blood, and in 
those states connected with internal inflammation, de 
mand an early and adequate abstraction of blood. 

SECTION XII. 

Oppressed action. 

A very common and one of the most alarming pheno- 
mena, attendant upon the attack of fever, and even for 
some days after, is a state of universal depression, or op- 
pression, or " suffocated excitement." 

The system universally partakes of the same torpor, 
that is most manifest upon the surface. The heart is 
unable to respond to the pressure of the column of blood, 
sufficient to restore the customary circulation ; and yet 
the pressure is not so great as to destroy life suddenly. 
Sensibility and irritability are diminished in the internal 
organs, which require large doses of customary medica- 
ments to produce any desired effect. Congestions form 
in the numerous capillaries, and the blood is deficient of 
oxygenation. It is in this state of disease, that the pul- 
sations at the wrist are often wanting in spotted fever, 
yellow fever, &c. In other habits of fever, and in those 
last mentioned, when not so violent, the same torpor is 
manifested in the kidneys by scantiness of urine, and in 
the bowels by constipation. 



SECT. XIV. PHENOMENA OF FEVER. 171 

SECTION XIII. 

Unequal action. 

The foregoing observations may serve to give sonic 
idea, with respect to the inequality of excitement or ac- 
tion between the surface of the body and internal parts ; 
but there is still manifest, in almost every fever, an un- 
equal action with respect to particular organs. One 
organ or part of the body may be in a hot and throbbing 
state, whilst another is more cold and torpid. This 
state is often discovered in the head and feet. The inter- 
nal viscera often partake of these different states of 
action. 

A great desideratum in the practice, is to restore 
equality of excitement. 

SECTION XIV. 

Remissions, paroxysms, periods of fever. 

Fevers are known to remit, and they have been dis- 
tinguished by different names according to the periods of 
accession, in some instances. They have had various 
periods assigned them for their crises or solutions, &c. 
Now it appears manifest, that different subjects have 
different degrees of susceptibility, and different degrees 
of irritability, and responding actions. It also seems 
demonstrable, that the force of morbid impression in 
different diseases, is very different. Where the morbid 
impression is violent, the corresponding action may be 
supposed to be violent. This furthermore will be ac 



172 PHENOMENA OF FETEK. CHAP. IV. 

ceded to, that the system cannot sustain a violent action, 
so long as it will a gentle diseased action ; for this rea- 
son, it must terminate in health or death sooner, and the 
more gentle may be sustained longer. 

The preternatural action of the sanguiferous system 
cannot be sustained beyond a certain degree, suited to 
its energy, without falling back to a state of quiescence 
more or less complete; — when complete, it is the state 
of death ,• — when partial, it is a state of remission, or a 
pyrexy ; and this takes place, when the proximate o t tUOt 
of disease is partially overcome. It being therefore 
only partially overcome, again accumulates from a con- 
currence of various causes, and the paroxysm is renew- 
ed, and acted over again ; but with different degrees of 
force, according as the action of the system has been 
regulated by the applications ; so that these may be 
rendered longer and more mild, or shorter and more 
violent. Hence it is that pure intermittents may be 
suppressed in their paroxysm, or may be converted, by 
bad management, into continued fevers. The like ana- 
logy will hold good in all fevers, although the remis- 
sions cannot always be so distinctly observed. 

Hence also we discover much irregularity in the ac- 
cess of paroxysms in intermittents, and also much irre- 
gularity in the exacerbations of continued fevers of the 
epidemic kind. Some of the most violent of these last, 
terminate in health in two or three days; and again 
some of the milder species continue for weeks. In the 
former case, the proximate cause may be supposed to be 
effectually removed ,• whilst in the latter case, it remains 
unmoved ; and also other changes take place in the sys- 



SECT. XIV. PHENOMENA OF FEVER. 173 

(em, which, along with the influence of habit, serve to 
perpetuate the disease. 

As observed before, the sanguiferous system inclines 
to a state of repose from violent action, like the muscles 
of loco-motion ; and also like the muscles of respiration. 
Hence in much exercise, the muscles tremble, and seek 
repose as in the remissions of convulsions. In difficult 
respiration, remissions are sought for, and often enjoy- 
ed. The same analogy is discoverable more or less in 
the heart and arteries. A sort of vacillatory remis- 
sion happens when the cause is not removed, attended 
sometimes with what some call a sinking faintness ; in 
these states of the system, the pulse varies in frequen- 
cy and force. A miniature of the greater remissions may 
often he discovered in the pulse of patients iu spotted 
fever, particularly iu the fore part of the fever. The 
pulse varies oftener, sometimes, than every half minute. 
It has been my practice, occasionally, to take a little 
blood at this time; and whilst the blood is running from 
a vein in the arm, it will often jet with some force, and 
perhaps in twenty seconds, fall back so as to trickle 
down the arm,* and again, in about the same time, flow 
in a considerable stream. These jets and remissions 
may be alternated several times, while the blood is flow- 
ing. 

The irregularity of paroxysms in all fevers, raises a 
doubt in the mind whether they depend very much on 
external circumstances. It is possible they may be vari- 
ed by these. The most striking instance is, that fevers 
are observed to be less vehement in the latter part of the 
night. It is probable, that the former habitual state of 



174* PHENOMENA OF FEVER. CHAP. IV. 

quiescence may have a share in this ; perhaps also the ab- 
sence of the stimulus of light, heat, exercise, and noise > 
or diurnal influence may have a share in this business. 

There seems to be no assignable period for the termi- 
nation of epidemic fevers ; although they may generally 
terminate within one or two weeks ; yet they may termi- 
nate in a few hours; or be protracted, under other cir- 
cumstances, for months, or even years. Writers on the 
plague mention it as continuing in the form of slow 
fever for thirty or forty days, in some cases. 

This is common in this country in dysentery, angina, 
spotted fever, &c. Indeed it may be asserted, that the 
host of chronic complaints, that follow febrile diseases, 
are nothing more or less than the fever imperfectly or 
partially cured ! 



Having passed, in a short review, the principal phe- 
nomena of fevers, as they appear separately and in con- 
cert at their commencement, it may here be observed, 
that many and various symptoms arise in the after pro- 
gress of the disease, depending so much on adventitious 
circumstances, that it is thought proper to pass them in 
silence. 

An attempt will now be made to propose a method of 
cure, as far as it can be considered in common, and on 
general principles. Brevity will be observed ; and par- 
ticular illustrations reserved to be considered in the 
treatment of the different habitudes of fever. 



CHAPTER V. 

ON THE TREATMENT OF FEVER, OR FEBRILE ACTION 
IN GENERAL. 

" Thou Good Supreme ; 

" teach me what is good." 

SECTION I. 

On the first or depressed stage of Fever, 

From all the previous considerations brought into re- 
view, it manifestly appears, that the ledantia, or hurtful 
principles, whatever they may be, have a tendency to 
impair, or injure the regular healthy action of the living 
system. In consequence of this derangement from im- 
pressions in the susceptible fibres, and irritable organs of 
the body, various, deficient, excessive, and convulsive 
actions arise in the system ; all having a tendency, when 
extreme, to impair, to deprave, and to destroy the eco- 
nomy of the living system ; but when moderate and well 
regulated, tend to restore the dissevered action, and 
perpetuate health. 

In a perspective review of the juvantia, or things use- 
ful to the restoration of healthy action, in the tumultu- 
ous state of febrile commotion, three cardinal objects are 
presented for primary consideration. 

The first is, to consider whether the first impressions 
upon the system, which have a debilitating effect, are in 



176 TREATMENT OF FEVER. CHAT. V. 

danger of abstracting the vital principle, and inducing 
sudden death. 

The second is. to consider, whether the vehemence of 
febrile commotion is in danger of immediately exhausting 
excitability generally, or of destroying the function or 
structure of any particular organ essential to life. 

The third is, to consider, if the preceding states have 
passed by, whether the continuance of febrile excitement 
is in danger of depraving the integral state of the solids 
and fluids, rendering them unfit for the restoration of 
healthy action ; which event must immediately or ulti- 
mately terminate in death. 

If such tendency is discoverable in either of these three 
grades of disease to any considerable extent, the conse- 
quences ought to be apprehended as of serious import, 
and remedies should be applied to obviate the fatal ef- 
fects. A consideration of these circumstances will com- 
prise the whole of the method of cure in fevers. 

It may here be observed, that the different kinds of 
treatment may not be so greatly diversified, as the seve- 
ral grades might seem to imply ; but rather having 
respect to the degree of diseased action, the force of 
remedies need be adapted to suit the particular state of 
morbid excitement ; the general curative indication re- 
maining very nearly the same. It was, therefore, 
thought necessary to make the foregoing divisions more 
for the purpose of discovering the most obvious danger, 
and pointing out the varied applications, rather than for 
the purpose of introducing a new catalogue of remedies ; 
for as diseases vary more in degree than in kinds, so the 
application of remedies should engage our attention more 



SECT. I. TREATMENT OF FEVEU. 177 

ill quantities than varieties. The business of the pbysi- 
eian is to attend more to the regulating of the action of 
the system by known remedies, than searching after new 
ones by unwarrantable and precarious experiment. 

In every attack of fever, there is experienced more or 
less depression; but it is only in the more violent attacks 
of pestilential diseases, that serious consequences are to 
be apprehended in the first grade of the disease. In the 
more mild attacks, the energy of the system is raised 
spontaneously as an invariable consequence of all im- 
pressions, proving stimulant, if limited to a degree of 
mediocrity. But if the impressive power is very great, 
and the energy of the system retires before it, vitality 
may suddenly be extinguished. Numerous instances 
of this are recorded in the plague; many also in this 
country in the yellow fever; and many also in this 
state in the spotted fever, dysentery, angina, and others. 
A short account is given in Chap. iv. Sect. 2, as relating 
to this state of disease, which may be adverted to.* 

We have perhaps arrived to the most difficult and the 
most controverted part of our subject. The limits of our 
design forbid much proof in detail. Propositions will be 
offered, and must be accepted at present, which are the 
fruit of no small share of observation and experience. 

* This state of disease is always attended with the greatest 
degree of morbid impression and derangement, called by some 
asthenia, connected with affections of the sympathetic nerves. 
The sthenia or high inflammatory state always supposes a less 
degree of morbid impression on the same parts ; or after the 
more violent impression is removed ; or that the principal lo. 
cality was upon the more dense membranes. 



178 TREATMENT 0! FEVER. CHAP. Y. 

The access of the diseases of the more violent grades, 
is generally most astonishingly rapid. Changes take 
place like electricity; but except in the instances of 
convulsions, spasmodic pains, and delirium, they pass 
unnoticed in part by the patient, and the inattentive ob- 
server; from this circumstance, that there is a kind of 
insensibility connected with the attack from nervous tor- 
por. In the mean time changes are going on in the inter- 
nal membranes of much importance. The action in the 
sanguiferous, lymphatic, and nervous systems, is une- 
qual and perverted, and the whole to be suddenly destroy- 
ed, if not suddenly remedied. 

The question is, what shall be done? — The scene 
becomes the most interesting, that the physician meets 
with. Decision, promptitude, and energy, should attend 
every step; not so much for the purpose of doing a great 
deal, as for the purpose of doing what is necessary with 
correctness and despatch. Nature cannot here sustain 
violence in any thing ; yet remedies should be efficacious ; 
but not such as greatly agitate and exhaust vital energy. 

If our pathological views are correct, as seems to be 
warranted by symptoms and dissections, there is a retro- 
cession of action and circulation from the surface of the 
body, the extremities, &c and an accumulation of fluids 
to the internal and more essential parts, with inor- 
dinate vascular action. The great objects to be had 
in view are to restore equality of action, and preserve 
the internal and more noble organs. 

The surface of the body claims our first attention. — 
Let warmth be immediately applied, if possible in a hu- 
mid form. The universal warm bath is preferred, of 
moderate warmth, and continued for a good length of 



.i.U'. I. TREATMENT OF FEVER. 1T9 

time. If (his is impracticable, let blankets be dipt in 
warm water, and applied extensively, several thicknesses 
over the whole body. Frictions occasionally used over 
the whole body by flannels, or a woollen glove, moistened 
in warm spirit, in which Cayenne pepper has been in- 
fused. As soon as these are got in operation, let three 
or four epispastics be applied; two of them should cover 
the ankles anteriorly, and two on the arms, a little below 
the shoulders. External warmth should be continued ; 
but managed discreetly, or tbe applications may do more 
harm than good. The object is first, to restore warmth, 
then to promote diaphoresis, and next to support them. 
When these objects are obtained, the wet applications 
should be removed, and warm'and dry ones substituted, 
and continued twelve, twenty-four, or forty-eight hours. 
These warm and moist applications are manifestly of par- 
ticular service in relieving the tonic stricture of capillary 
vessels, both on the surface and subjacent parts. 

Much must be left to the discretion of the attendant; 
and for want of some simple variations, the good effects 
may be lost. The air in the apartment should be free, 
pure, and moderately cool, and not crowded by idle spec- 
tators. 

It may here be remarked, that from much observa- 
tion, our conclusion is, that the state of the skin is too 
much neglected in general, in the cure not only of epi- 
demic diseases, but also in the cure of a great proportion 
of internal inflammations in both chronic and acute dis- 
eases. Hence the use of blistering, frictions, bathing, 
anointing, &c. These are commonly mentioned as only 
secondary measures* when they are of primary impor 



180 TREATMENT OF FEVER. CHAP. V. 

tancc, and are the first measures to be set about for the 
purpose of giving a favourable operation to other re- 
medies. * 

Blood-letting and puking often fail in producing their 
good effects, for want of proper attention being given to 
the circumstance of the application of warmth to the 
skin. Fiom this circumstance, many have concluded 
that blood-letting is useless, or hurtful, when it is abso- 
lutely necessary, and might have been of singular service, 
if it had been aecompanied with suitable warm applica- 
tions to the surface. Steam of hot water is often good, 
but is apt to be unmanageable, and attended with too 
great heat. 

How far Mr. Jenning's apparatus will succeed, I am 
unable to determine, having had no opportunity of prov- 
ing it ,• we are disposed, however, at present to think 
favourably of it.f 

The internal surface, of which the stomach is the 
principal, claims our early attention. Let this be rather 
invigorated by agreeable things, than debilitated by op- 
pressive ones. Puking is apt to attend, and needs to be 
suppressed in this stage rather than increased. 

* See Cullen on the manner of sweating. 

+ Since writing the above, a fortunate circumstance has put 
me in possession of Mr. Jenning's apparatus. It consists of a 
tube reaching from the floor to the patient in bed ; at the 
bottom of which is placed a cup of burning alcohol, (common 
spirit.) The vapour or gas passes around the body of the 
patient, and gives a very agreeable and invigorating warmth, 
and without moisture. I have very lately made various trials 
of it, and it has more than answered my expectations; and 
cannot but regret not having known its use before now, in the 
treatment of spotted fever, dysentery, colic, &c. 



SECT. I. TREATMENT OF FEVER. 181 

If sweating succeeds well, the irritation is frequently 
removed from the stomach, which is very desirable. 
The stomach should be supplied with warm aromatic 
tea-drinks, such as sage, balm, saffron, thyme, orange 
peel, senega root, &c Also coffee, tea, animal broths, 
if agreeable. Also may be used some of the more agree- 
able essences of box-berry, peppermint, lavender, cinna- 
mon, camphire, ether, &c. in small quantities with warm 
water, and often repeated in such a manner as to be plea- 
sant to the appetite, to promote sweating, but not suffi- 
cient to irritate essentially by their stimulus the heart 
and arteries. Upon this consideration such remedies 
should be given, as are of very diffusible and transient 
operation, to affect the lymphatic and nervous systems, 
without leaving any durable stimulus upon the arterial 
system. Pages might be writteu to tell what should not 
be done ; but, for the present, in this stage of the busi- 
ness, it will only be proposed, that emetics, opiates, calo- 
mel, brandy, and other high stimulants, and whatever 
greatly agitates, be withheld, or used with much caution. 

Many circumstances in detail on this subject will be 
passed over, for the present, whilst we hasten to the re- 
lief of the more important functions of the heart and 
arteries. These are gorged with blood, less perfect than 
in health. Congestions are already forming more or 
less, in different parts of the viscera of the head, thorax, 
or abdomen ,• according as the peculiarity of the predis- 
ponent causes, and constitutional propensity, may have 
induced. The object of the second part of our indica- 
tion, is to preserve the internal organs from irreparable 
injury. The time is rapidly passing when our efforts 



182 TREATMENT OP FEVER. CHAP. V. 

will be fruitless; let it then be improved. Immediately 
upon the application of warmth to the surface, and light 
diffusible cordials to the stomach, take a little blood ; 
perhaps two, four, six, or eight ounces, according as the 
patient may bear it. If he is a little faint, it is nothing 
but what is common ; a little time will remove it, as the 
blood-vessels contract. The patient should always be 
warm, and in a recumbent posture, when bled at this 
stage, vshich is supposed to be the first stage, and suffer- 
ing under oppression. If the pulse is very small and 
trembling, it is no serious objection to taking blood ; nor, 
in fact, if the faintness should be of considerable dura- 
tion, will it be an objection to taking more blood, soon 
after the recovery from this condition. Patients bear a 
second bleeding, in this condition, better than the first ; 
and the blood flows more readily. Large bleedings would 
not be proper at this time, but they should be repeated 
until pain, distress, and coma, are relieved. Proceed 
with caution ,• but be not over cautious of a little blood, 
when the safety of the patient requires it. The conges- 
tions must be prevented, or removed, and the free circu- 
lation promoted in the minute vessels, or all is over. 
What will do it ? — Cordials, stimulants, tonics, have all 
been tried ; yet no real permanent benefit arises. The 
patient may indeed sometimes feel a little more comfort- 
able from a dose of opium, and a gill of wine, for a short 
time ; but in every serious case he is sure to be left 
worse ; unless, peradventure, the ease may not be so se- 
vere as was imagined, and along with this the other 
curative means may have had a happy effect, and at 
length, he is found better : and at the same time very 



SECT. I. TREATMENT OE FEVER. 18.J 

Willing lo impute the benefit to the most agreeable reme- 
dy; and not only this, but is willing to attest his since- 
rhy, and prove the skill of the physician, by repeating 
the dose ; — it is done, and again : but shortly neither 
knows nor cares what is done ! — The success of some 
cases of spotted fever, more purely spasmodic, and as 
connected with sweating, has given much celebrity to 
the use of opium and brandy; but as foreseen by many, 
they have not yet atoned for the injury they have done. 
One circumstance must be adverted to in this place, 
and it is done with pleasure, to give credit to this best of 
remedies in suitable cases. The instances do not happen 
very frequently ; but sometimes in spotted fever, and 
sometimes in dysentery, approaching to the character of 
cholera morbus, there will be an incessant puking, at 
the onset of the disease. Every thing that is taken, is 
thrown up, and the secretion into the stomach is so great, 
that seemingly four times the quantity is thrown up, 
that was taken down; resembling the vomiting of peo- 
ple dying of acute inflammation of the mesentery, &c« 
A large dose of opium, followed with brandy and loaf- 
sugar, is of singular service in such cases; possibly they 
may need to be repeated ; but this as circumstances may 
require ; but always having regard to reduce afterwards 
the febrile aetion, which they may induce, by blood-let- 



ting. 



Let it be noted in this place, that the measures pro- 
posed, will most commonly succeed in giving energy to 
the heart and arteries ; but in certain instances, in the 
attack of fever, and in certain other states of fever, from 
a recurrence of atony, perhaps principally from a neg*- 



184* TREATMENT OF EEVER. CHAP. V. 

lect of mild cordials, and neglecting warmth, the patient 
is alarmed with what is called a sinking state. If this 
should be any considerably threatening, a moderate dose 
of opium may be interposed. In these instances, the re- 
covery should be principally trusted to wine and essences, 
with external warmth. No more should be given than 
to support in a moderate and judicious manner. In these 
conditions, if the pulse is slow, as well as retiring, the 
chance of success is very good. If the pulse is very 
quick and retiring, the highest stimuli will generally be 
ineffectual. It is safer to trust to moderate stimuli, and 
the returning energy of the heart, than to be over solici- 
tous, and stimulate beyond what the system is capable of 
bearing. 

But to return ; — it is objected by some, that the pros- 
tration of strength is great in the system generally, and 
in the arterial system especially. It may be granted; 
but what is the particular nature of this debility ? Was 
not the patient strong and plethoric, a few hours before ? 
Has he not been free from any great evacuations ? — Not 
only this, but we know that evacuations made from a 
person in health, to a great extent, do not produce the 
degree, nor the kind of debility, we now discover. Every 
symptom and circumstance discoverable warrants the 
conclusion, that it is debility from oppression; that the 
system is suffering violeuce and danger from an unequal 
circulation ; engorgement in some organs, whereby their 
functions are hindered, and the system at large suffers 
for the want of the usual discharge of their offices. This 
is conspicuous in the lungs and brain more particularly; 
it is not now, strictly speaking, inflammation, but con- 



»ECT. 1. TREATMENT OF FEVEK. 185 

Motion. If the patient survives this stage, another and 
more commou eoncourse of symptoms supervenes, and 
often verv quickly. 

Fur flier, it is agreeable to the laws of physiology, that 
• un^estion in the head, by pressing the brain, and per- 
verting the functions of the nerves, should induce debi- 
lity, and even paralysis ; and a little more induces apo- 
plexy, and even death. All these stages actually have 
been witnessed in the onset of every epidemic fever of any 
importance ; perhaps more particularly in that species 
called spotted fever; as its principal seat of locality is 
mostly confined to the head. We have here to contend 
chiefly with the first grade of impression, viz. congestion, 
not inflammation, provided we go about it in season. It 
is, at the same time, something more than mere mecha- 
nical pressure ; there is a violent propensity to vascular 
action, constituting the very essence of fever; but the 
large vessels cannot act naturally. Wny ? — For this 
familiar reason ; that they are too full ; and also that 
their ability of actiug is diminished from an abstraction 
of nervous energy. What shall be done ? Shall we fold 
up our arms, and say, his time is come/ when he might 
be relieved in many instances with a little exertion ? We 
do not always have the opportunity of seeing, and do- 
ing what is necessary for our patients, under the most 
propitious circumstances. Human judgment may fail 5 
illiberal opposition is wont to have an insensible effect 
upon the most inelastic mind. But still the principle is 
plain, and should be persisted in; not only cases, but 
years of observation confirm it. 

2* 



186 TREATMENT OF FEVER. CHAP. V. 

In certain habitudes of fever, affecting the abdominal 
viscera more particularly, a certain train of symptoms 
arise, in some measure resembling those from cerebral 
affection as to debility and prostration of vitality; but 
still, in many particulars, they are attended with diffe- 
rent phenomena. The general indication, notwithstand- 
ing, is the same ; and very nearly the same applications 
at the onset of the disease. By pursuing a depleting 
method, with external applications, in due season and 
quantity, the small, quick, receding, or vacillating pulse, 
in dysentery, in spotted fever, in gastritis, &c. may be 
changed most commonly into a more full, slow, open 
pulse of the more distinctly marked sthenic diathesis ; 
and when in this state, becomes very manageable, and 
the patient removed from the highest grade of danger. 
The objectors to this management say, that the sys- 
tem is in a manifest state of debility. This is granted; 
and for the very purpose of removing this debility, 
warmth is applied to the surface ; it is the first thing 
proposed, and the most to be relied on of any one applica- 
tion. Life cannot be supported a moment without an 
adequate share of heat ; it is indispensable. Hence 
the great provision in the system for the generation 
of heat. In disease, that is, in the first stage of fe- 
ver, this power of generating heat is diminished ; and 
if the cause of its failure is not removed, in part at 
least, the ability of generating heat will be destroyed, 
which is nothing different from a state of death. With 
this view, and to avoid this calamity, heat, which is sti- 
mulating, is applied to the surface of the body, which is 
at all times to be approached ; and also this is the very 
part, that suffers most from an abstraction of energy. 



SECT. I. TREATMENT OF FEVEK. 187 

The impoverished vessels of the surface arc again 
brought to life, and filled with fluids for their own sup- 
port, and for the relief of other parts, that are suffering 
from an engorgement of retrocedent fluids from the sur- 
face to the centre. Whilst debility prevails, the stimulus 
of heat must be continued, or until the circulation is 
permanently established on the surface; when this takes 
place heat should be diminished. 

The variation of these measures should be determined 
by the physician. His judgment should be formed by 
experience, and this will enable him to suit the peculiari- 
ty of treatment to each particular case. As an appro- 
priate degree of the stimulus of heat is necessary to the 
life of man, so any degree of cold or abstraction of heat 
from this salutary point, is an assault upon life. 

It is still objected with respect to blood-letting, that 
this is a debilitating measure, and abstracts a portion of 
heat. It is replied, that this is not debilitating, where the 
vessels are overloaded, but that it is actually invigorating 
in these circumstances, as can be proved upon physiolo- 
gical principles, and demonstrated to the observer. The 
case under consideration is where the repercussion is 
great from the surface to the central great vessels, at- 
tended with anxiety, coma, &c. The demonstrable fact 
is, that by diminishing the pressure in the heart and 
great vessels, their action is more energetic, the remain- 
der of the blood is better circulated and distributed to 
the capillaries, carrying along with it heat, which further 
contributes to relax stricture, open obstructions, promote 
sweat, and give equality of excitement. If it fails in doing 
this last effectually, it has the effect of giving freedom 
and expansion to the circulation, and thereby changing 



188 TREATMENT OF FEYER. CHAP. V. 

an otherwise incurable state of disease, of what is called 
malignant or ataxic, into one that is generally consider- 
ed much more manageable, called inflammatory or 
sthenic. 

If it should still be objected, that the debility is alarm- 
ing, and reduction will not do, let it be remembered that 
life may be sustained by a very feeble action, and by 
stimulating we frustrate our own designs by increasing 
the action beyond the ability to support it. 

Let us for a moment put aside all reasoning upon the 
subject, and advert to facts. We do know thai b\ bleed- 
ing, momentary relief is obtained from the pain between 
the eyes in spotted fever, immediately after the attack; 
also pain generally. We are also sure that the pulse 
grows larger, and approaches more towards those states 
of fever, that are more manageable. We are also well 
assured, that the circulation becomes more natural in 
every part of the body by this operation, and that it is the 
surest remedy at our command to remove cold chills. We 
have not experienced the injuries contemplated by some 
although we have had the fairest opportunity ; not only 
in the last mentioned disease, but also in epidemic pneu- 
monia, in dysentery, and in angina, in their most alarm- 
ing appearances. 

From what is now urged in favour of blood-letting in 
the commencement of fever, it need not be understood, 
that it is proposed as proper in every case ; far from this$ 
many cases appear of a milder nature, which do not re- 
quire this remedy so early, nor at a future time, so 
largely. Again, many cases appear more purely nervous, 
and without much pain or eoma, with a very feeble pulse. 



SECT. I. TREATMENT OF FEVER. 18* 

Bleeding unquestionably should be deferred in these 
cases, until symptoms may demand it more; and in the 
mean time the patient be treated with sweating, blisters, 
and mild cordial*, until pain, quickness of pulse, or coma 
may require it. 

A further consideration of much importance, in this 
place, is, that if we feel under the neeessi y of giving 
opium, ardent spirits, wine, &c. to keep up the energy of 
the nervous power in any particular case, our patient will 
feel more present benetit by a little emptying of the 5>lood 
vessels by bleeding, and will not be so likely to suffer 
from the after consequences of the stimulus. From 
much observation, it appears, that in the present instance 
of supposed mere congestion, it makes but little difference 
from what part of the body the blood is taken; the arm 
is generally preferred. 

A few hours of the case having passed by, the physi- 
cian will have time to consider, whether it may be expe- 
dient to give an emetic ; if he has already vomited, it 
may not be necessary ; if he has not, it may be necessary 
to give a very gentle emetic. We are now supposing a 
very violent attack under the preceding circumstances; 
if the case is moderate, free use of emetics may be in- 
dulged, and they will often assist in distributing an equal 
action to all parts of the body, and assist in removing 
disease. But in the more serious and alarming cases, 
their operation is often hazardous ; they are apt to go to 
excess; they propel the blood into the brain, and if they 
are not successful in promoting the circulation on the 
surface, and overcoming the capillary torpor, may do 
much hurt. Notwithstanding, if there is no vomiting, if 



190 TREATMENT OF FEVER. CHAP. T. 

the patient does not sweat, and especially some nausea 
attends, it may be proper to give an emelic, but of the 
smallest dose, that may answer the intention. It ought 
to be kept in mind, however, that where there is a defi- 
ciency of vital power, emetics are of doubtful, if not 
dangerous tendency. 

As a further means of acting upon the internal surface 
and thereby exciting universal action in the system, ca- 
thartics may be employed under various circumstances 
to suit the particular habit of disease. In almost all 
cases they become useful after the first state of depres- 
sion has passed away in part. They relieve the head, 
and, under prudent management, assist in relieving con- 
gestion in every organ, and thereby give energy univer- 
sally. The necessity of their use is different in different 
habits of disease. In cases of great prostration of 
strength both cathartics and emetics are of doubtful ten- 
dency in the first hours of disease. They expend more 
vital energy in proportion to the relief they give, than is 
done by bleeding and sweating. As soon, however, as 
the system begins to emerge from the state of dangerous 
depression, they become useful auxiliaries, and much 
depends on their assistance to relieve torpidity, and pro- 
mote equality of excitement. The revulsions and evacu- 
ations they make are often indispensable. 

In those cases of severe attack in epidemic fevers, 
attended with the preceding symptoms and circumstan- 
ces, if the action of the system does not emerge sponta- 
neously from its depression, if it is not relieved by art, 
and at the same time is not sufficiently powerful to prove 
suddenly fatal, a concourse of symptoms arises that are 



SECT. 1. TREATMENT OF VEVEIt. 191 

truly alarming, and such as have been denominated ma- 
Uziuint and putrid; but it would be well for the science 
of medicine, if these words were expunged from our dic- 
tionaries, as they too often lead the mind into error, like 
other qualifying names of diseases.* But to return, 
this condition of disease is manifested, in a considerable 
degree, in the first onset ; in a short time is made more 
manifest by an increase of symptoms of the former at- 
tack, and some new ones, as is sufficiently described by 
different authors treating on the several diseases so nam- 
ed. See Sect. 3. 

The business of the physician is to prevent this black 
catalouge of symptoms if possible by limply applications, 
and so change the state of action, that the system may 
rise into universal high state of excitement. The busi- 
ness seems some times, when improperly managed, to 
proceed in this manner ; — take the preceding condition 
of the case alluded to in the extremity of the first attack, 
but suppose it not so violent as to prove suddenly fatal ; — 
let the patient be treated with tonics and strong cordials, 
and avoid evacuations for fear of lessening his strength ; — 
also avoid external warmth ; — .the sanguiferous system 
labours vehemently to restore the derangement made by 
the first impressions, but is unable to do it; — the torpor 
or hindrance in the capillaries is great and cannot be 
overcome by the energy of the heart, now already em- 

* If the qualifying word malignant were to be used to ex- 
press merely an aggravated or high state of febrile impression, 
there would be little objection to its use; but if used as syno- 
nymous with putrid or pestilential, or to express any particu- 
lar quality of disease, its use becomes very objectionable. 



192 TKEATMENT OF FEVEH. CHAP. V. 

barrassed with a cumberous load of contents ; it acts 
spasmodically ; the strife and distress are great ; but by 
and by it grows more feeble ; the excitability is in part 
exhausted ; the disoxygenated blood begins to escape 
through the tender weakened vessels; or begins to stop 
in the congested ones ; the pulse quickens but grows 
weaker; as excitability retires, sensibility accompanies 
it; our patient grows colder and feels more easy ; and in 
a perfect state of indirect debility, "glides down the 
steep descent," with much composure. 

In some conditions of fever this irrecoverable state 
comes on much sooner than in others. But it is sure to 
approach sooner or later in all fevers of any considerable 
importance, unless the primary derangement is overcome 
spontaneously or by art. In yellow fever, angina, and 
spotted fever, it requires only a few days commonly ; in 
typhus fever, as many weeks. 

With a view to avoid these calamitous events, we must 
look to the consequences of the present derangement ; 
(" respice jlnem" ;) and from the first hour, calculate the 
probable issue. But we are called oftentimes to the bed- 
side of the patient under very adverse circumstances. 
Time may have passed that was precious; something 
wrong may have been done, or something useful may 
have been neglected; or we may have to consult with a 
man of different views, who must have his way in part, 
if not wholly. Let what will happen, our object in the 
early stage of these depressed cases, is to help the natural 
exertions of the system to diffuse an equal and energetic 
action over the whole. Only remove the obstacles, and 
nature will do it, if moderately assisted in season. If 



SECT. I. TREATMENT OE EEVEK. 193 

the obstacles are not removed in season; the indication 
still remains the same, to assist all we can. But it must 
he understood, that our observations, when speaking with 
any positiveness, are founded on the presumption, that 
our patient has all the advantages of time and opportu- 
nity; and then it will be asserted that there is a great 
probability of success even in the most forbidding condi- 
tions. 

It is asserted by some, that the disease should be taken 
out of the hand of nature, and cured. This is true, in a 
certain degree ; for the enthralled operations of nature 
lead to destruction; but when emancipated, conduct to 
health. 

Let us return more particularly to the object before 
us. Our patient has passed perhaps twelve hours of his 
disease, and four of them under our management. Does 
he sweat freely with general warmth ? — has he vomited 
from the emetic ? — does his pulse expand a little more ? — 
has his pain increased since it was mitigated by his for- 
mer bleedings ? — if so, let him be bled again ; and con- 
tinue the external warmth, and also the most agreeable 
nutritious diluents. There is hope, that the disease 
will be diffused over the whole system, and eliminated at 
every pore in due time. 

Propositions may be laid down, but they must be gene- 
ral. Unlike all others, the art of medicine must bend to 
the case of the patient ; — prescriptions may be straight 
on paper, but they may not suit the curved case of the 
patient ; this may have as many points as there are de- 
grees in a circle ; therefore it is said, every man may be 
a theorist, but every man may not be a practitioner, 

25 



194 TREATMENT OF FEVER. CHAP. V. 

This consists in a facility of arranging the remedy to 
apply to the particular case of disease. It is the product 
of laboured culture in a congenial soil. 

SECTION II. 

On the second stage of fever* or high excitement. 

We have passed in a rapid and rather insensible man- 
lier from the first consideration proposed to the second. 
It is now supposed, that the patient labouring under any 
violent epidemic disease, has emerged from the great 
degree of prostration of strength and oppression, which 
is often alarming 3 and it is now supposed that the re- 
sponding action in the system is violent, with pain, per- 
haps coma, or delirium, and other signs of violence in 
some of the essential organs. 

The particular condition of the patient may be chang- 
ed, but. our indication is not changed, and will not be 
until he is cured. Although the heat may be equal over 
the whole system, yet equality of action is not yet restored 
in the absorbent system ;— if it were, ease and health 
would be the result. Nor are the internal organs safe, 
but still suffering. 

It is hoped a little digression will be pardoned, while 
we indulge in a few pathological similes, which seem to 
appertain to the present subject. Much unprofitable dis- 
putation has arisen upon the consideration, whether the 
general diathesis produces pain and local affection ; or 
whether the local affection produces the fever ; which 
has thereby been denominated symptomatic by some. 
Without going into any recapitulation pf the different 



SECT. II. TREATMENT OF FEVEIt. 195 

arguments, it will be asserted, that they are both from 
the same fountain, are similar in their nature, and to he 
relieved by the same remedies. Sometimes the pain is 
discovered iirst, or before the febrile diathesis, as in 
strangulated hernia, in colic, in pleurisy ; in various parts 
in spotted fever, ecc. Sometimes the fever is clearly 
manifest, before there is any considerable pain or local 
affection ; and when the pain affects a certain part, it is 
liable to be translated suddenly to some other part, until 
such time as the general diathesis is overcome by proper 
remedies. A person possessing a well balanced habit, 
not liable to local affection, may receive an impression of 
disease, and it may have made some progress before such 
local pain excites attention. At the same time it is often 
observable by valetudinarians of an irritable fibre, and 
such as are moved by slight causes, that upon a little 
exposure to cool damp air, they will be attacked with 
pain somewhere, before they have thought of being ex- 
posed ,• perhaps it may be in some of the internal parts ; 
it may be in a defective tooth, or in some of the mem- 
branes of the firm parts, where they have formerly been 
affected with rheumatism ; or perhaps it may be in the 
muscles in the form of spasm or cramp ; and this last 
develops the true character of the pathology jof the 
affection. It is all cramp; or if you please, nervous 
stricture, tonic spasm, permanent torpor; or if a more 
technical phraseology is required, the reader is request- 
ed to suit himself.* 



* Although these terms have been used rather indiscriminate- 
ly, it may be understood, that tonic spasm is meant more par- 



196 TREATMENT OE FEVER. CJHAP. V. 

In the first place a sort of constriction or corrugation 
is distinctly felt in the skin by the patient, and discove- 
rable by sight | perhaps attended with slight chills, and 
perhaps not. Warmth is agreeable ,• cold is forbidding. 
Perhaps these changes pass unnoticed by the person if 
his mind is engaged, until he is warned of his danger by 
pain, which is only another part of the same constrictive 
operation. Perhaps this slight affection may be removed 
by a slight perspiration ; but suppose the impression to 
be more violent, and of some longer continuance, and in 
a subject predisposed to extreme irritability by the 
causes mentioned in Chap. in. and we have before us a 
case of violent epidemic disease, which claims our most 
assiduous attention. From a perversion of one organ, an 
injury is offered another, until perhaps the whole conca- 
tenation of healthy action in the system is broken. 

Possibly there may be a time in the progress of this 
business, when cordials, and those medicines that are 
called stimulants and antispasmodics, might be useful, 
and even overcome the impression ; but this time is very 
short ; it unquestionably is in the very beginning, when 
the subject feels most commonly a sensation of faintness 
at the stomach, or a desire for food. This soon passes 
off, and commotion arises in the several functions, when 

iicularly to apply to the first impression, which is made in the 
system through the agency of cold and exciting causes. Tor- 
por or impermeability should apply more particularly to the 
after conditions, that are discovered to exist in' the very pro- 
tracted state of fever and in chronic complaints ; it is therefore 
called permanent. It must be likened in this case to a state 
of paralysis; it is what was formerly called obstruction. 
See Chap. iv. Sect. 2; 



SECT. II. TREATMENT OF FEVEK. 197 

food and also high stimulants are abhorred, and indeed 
ought to be. 

To return more particularly to the subject before us; 
it is now supposed, that the disease is beginning to show 
its true character, by a more expanded operation and 
diffusion of action through the sanguiferous system ; but 
yet it is not perfect. The pulse quick, hard, and more 
full than before ; if pain was mitigated by former bleed- 
ing, it may have returned with violence. The stricture 
on the capillaries is not removed ; the heart and arteries 
act powerfully; the tension of the blood-vessels is great,, 
and must be relieved before the disease can be removed? 
or even rendered safe. The fulness and tension possibly 
may be relieved by emetics, cathartics, and other evacu- 
ations by the natural emunctoiies, if the patient is able 
to survive the long period necessary to accomplish it; 
and at the same time, this method would be more justifi- 
able, if we were sure that no important organ would suf- 
fer in the long conflict. But we are not sure of this; 
inflammation may commit great ravages in a part es- 
sential to life, and in parts nbt so immediately necessa- 
ry, abscesses mav form and waste the system. The 
greatest danger of all is, that the excitability of the sys- 
tem may be exhausted; indirect debility induced, when 
the case will assume the character of malignant, pesti- 
leutial, nervous, or putrid fever; or all together, as best 
suits the views of the physician, or the feelings of the 
friends. 

"With a view to avoid these evils, let us go about a 
method of cure, that is rational and justifiable from long 
experience. The very same means, that lessen pain and 



198 TREATMENT OF FEVER. CHAP. V. 

relieve the tension of the arteries, tend also to relax the 
stricture in the capillaries, and give freedom to (he ab- 
sorbents. Hence the indications of cure are not so 
numerous and complicated, as we are often required to 
believe. 

The simple rule is to take blood at repeated bleedings, 
until an easy balance is established between the heart and 
larger arteries on the one hand, and the capillary and 
ab*orbent systems on the other. It is altogether imma- 
terial how many bleedings may be necessary ; this de- 
pends on the quantity taken at a time, the violence of 
the disease, and the personal circumstances of the pa- 
tient. It will be best to take pretty full bleedings, and 
save the necessity of frequent repetitions. Large bleed- 
ings overcome the diseases of high excitement with the 
loss of less blood in the whole, than can be effected by 
smaller bleedings. Blood should always be taken in the 
paroxysm, if discoverable, of distress and fever. It 
should also be accompanied with external warmth, with 
a view to relieve the stricture on the surface and promote 
diaphoresis. Bleeding is the greatest of all remedies to 
excite diaphoresis in high arterial action with febrile 
heat, and the boasted effect of opium tends to suppress it» 
The very general effect of adequate bleedings is to re- 
lieve pain, to relax the constriction of the capillary ves- 
sels, to remove cold chills with distressing sweats, and to 
promote a salutary diaphoresis. 

The number of bleedings must be determined by the 
circumstances of the case. A very mild case may do 
without any ; one a little more severe, may do with one 
bleeding, and so on. Some cases require five or seven 



SECT. II. TREATMENT OF FEVER. 19* 

bleedings. In a severe case it will be impossible to take 
sufficient blood at any one time to render it tolerably safe. 
Suppose the symptoms are rendered mild by it now ; yet 
in a few hours, perhaps the responding action rises, the 
force is increased in the heart and arteries with pain. 
&c. and repetition becomes ueccssary. 

Let us attend, for a moment, to an objection made by 
some to the use of blood-letting in fever. It is asserted 
that upon one or two bleedings, they have found their 
patient labouring under more heat and pain than before, 
and are sure the disease was aggravated by it, and have 
therefore desisted. True, the state of action is altered 
by it, and this is the very thing desired ; only pursue ; 
take blood, until the violence of reaction is subdued, and 
the patient is out of danger. The road is plain ; and the 
way faring man need not err therein. 

It is of the first importance, that the patient be bled 
freely in the beginning of the disease, before congestions 
are fixed, the membranes inflamed, or the system become 
habituated to diseased action. If this is judiciously per- 
formed along with the use of sweating and other simple 
remedies, the disease may be stifled in the beginning; if 
it should not, the system will be enabled better to bear 
the after evacuations, that may be necessary to overcome 
the febrile commotion. If bleeding is omitted for some 
days, the patient does not bear it so well, and it does not 
do him so much good. Spare bleeding has always mis- 
led superficial observers into numberless errours ; and 
they have been induced to impute the fatality of the dis- 
ease to the very means that, under a timely and energe- 
tic administration, would have restored the sufferer to 



200 TREATMENT OF FEVER. CHAP. V. 

his now disconsolate friends. Notwithstanding the pue- 
rile objections that may he brought against ihis practice, 
the names of the greatest luminaries of medical science 
stand recorded in vindication of it ; to mention a few 
only, would be injustice to many. 

Whilst urging the use of these means, it should not be 
understood, that there is no limit to be set to them. 
Much attention and judgment are necessary to balance 
between extremes, particularly in such diseases as are 
subject to sudden and manifest remissions ; for in the 
state of apyrexy, the system may suffer from too great 
abstraction. This however it to be considered, that such 
diseases do not require so great depletion to render 
them safe. To discriminate in these circumstances, the 
character of the epidemic must be considered ; as 
whether it is liable to distinct remissions or apyrexy. At 
all events this violence of paroxysms must be moderated; 
and general opinion is against a sufficiency of depletion. 

A diaphoresis should be encouraged by the gentlest 
means ; the emetic will promote it ; but let the determi- 
nation be to avoid the heating alexipharmie medicines, 
composed of opium, spirit, and their deleterious auxilia- 
ries. They increase the inward flame and bind up the 
cuticular emunctories, and along with too heavy cover- 
ing and heated rooms without diaphoresis, drive the 
blood into the internal organs, and fix the fate of the 
patient. 

It must be here, and every where, kept in mind, that 
the action must be kept up on the surface more by exter- 
nal warmth, as baths, steams, frictions, &c. than by in- 
ternal stimulating medicines of any kind. These last 



SECT. II. TREATMENT OF FEVER. 201 

stimulate the heart and arteries more than is proper, 
Whilst their effects are but little felt in the remote and 
torpid capillary vessels on the surface or skin. Whilst 
moderate stimulants or cordials are used internally with 
mild and agreeable nourishment, let the weakened sur- 
face be invigorated by warm and agreeable applications. 
These warm external applications are truly invigorating, 
and have even something like an exhilarating effect. 
They restore warmth to the impoverished surface, in- 
vite the destructive pressure from the over replenished 
viscera, and equalize excitement in every part. 

In the state of weakened action on the surface, which 
prevails more or less in all epidemic fevers, it becomes 
an object of the first importance to be constantly watch- 
ful to see, even after the excitement has been restored on 
the surface, that it be not suffered to subside too soon ; 
if it should, there might be a retrocession of action with 
chills, faintness, distress, &e. In this condition the reme- 
dies will perhaps all need to be renewed again, and per- 
sisted in, until warmth and external vigour are restored. 

Those epidemics, such as angina epidemica, which 
have an eruption on the surface with high action, hear- 
ing a resemblance to the measles or small-pox, need but 
little external warmth, compared with those which have 
an internal determination, such as dysentery, spotted 
fever, &e. In the former more bleeding and less sweat- 
ing should be employed, whilst in the latter, less bleed- 
ing comparatively, and more sweating. In making these 
general observations, it is hoped the meaning of the 
writer will not be misapprehended. It will be noticed 
that the observation is intended to apply to those cases 

26 



202 TREATMENT OF FEVER. CHAP. V. 

attended with high action, or inflammatory appearance, 
in which hut little heat ought to he used. Many cases 
appear of a different state, with little or no eruption, or 
of darker colour, as in angina maligna, with much pros- 
tration of vital power and internal determination, in which 
external warmth is very beneficial. 

Conjointly with judicious bleeding and proper sweat- 
ing, moderate emetics may be employed, if puking from 
irritation is not present ; perhaps one every evening or 
every other evening, as the circumstances of the case may 
require ; but the distressing practice of perpetual nause- 
ating doses of emetics, should be abandoned. In the 
intervals of vomiting, the system should be refreshed 
with agreeable nutritious and diluent drinks. 

Cathartics may be employed to evacuate the prima) 
via?, and also to excite the action of the absorbent system 
by directly exciliug the lacteals, and by sympathy the 
whole lymphatic system ; and also by the evacuation 
they make, do something in relieving the tension of the 
system. The first cathartic employed in this second 
stage, may be calomel, combined with some common 
place physic, such as the common pill or rhubarb, &c. 
but the after operations, which may be repeated perhaps 
every other day, should be composed of a proportion of 
the neutral salts, joined with mild purgatives. If the 
disease, however, should be continued for any considera- 
ble length of time, calomel may occasionally be inter- 
posed as a cathartic. 

Blistering should be used on different parts of the body, 
according to the violence of pain. They should generally 
be applied to the pained part. In delirium they should 



SECT. II. TREATMENT OF FEVER. SOS 

be applied first upon (he anterior part of the ankles, and 
next upon the baek of the neck. In ease of low and pro- 
tracted fevers, a blister should be applied to some part 
of the body about every twenty-four or forty-eight hours, 
unless strangury forbids it. 

Particular regard should be had to the state of the 
skin. By far the greater part of cases in epidemic fe- 
vers requires a considerable degree of warmth ; more 
particularly if perspiration can be promoted by it; and 
it should be used sometimes to bring forth a moderate 
and even profuse sweating; sometimes, however, the 
heat will be extreme on the skin, and it seems impossi- 
ble to induce any sweat by reason of too high excite- 
ment. In such cases, wetting the body with cold water 
by means of linen cloths, has been useful ; and especial- 
ly the head, if there be much pain or delirium. This 
will be more safe after proper evacuations, especially by 
bleeding, have been made. 

The use of cold water by ablution is not proper in the 
commencement of fever ; and only in those high states 
of temperature, that sometimes take place in all fevers, 
and more frequently in scarlatina anginosa. It is often 
a doubtful remedy, and not to be employed unless clearly 
indicated. It is not to be used where there is inter- 
nal pain and local inflammation ; and only when there is 
an equally diffused action; and a well directed use of 
other remedies will supersede the use of it in nine- 
teen cases out of twenty. Linen cloths dipt in warm 
soap suds, and applied from the feet to the hips, will 
often supersede the necessity of applying cold water to 
the head, and is better adapted to the final cure; for if 



20* TREATMENT OF FEVER. CHAP. V. 

cold water is applied too early, while pain, stricture, and 
congestion, are permanent, the reaction, that occurs 
after its use, is often alarming. 

Whilst considering the use of cold water externally, 
we will advert to its use internally. In certain cases of 
high excitement, manifested by hot skin, and dryness in 
the mouth, and internal surface by extreme thirst, and 
especially after some continuance of the fever, with an 
abatement of local pain, cold water becomes a sovereign 
remedy. The patient may take liberally, if it continues 
to be agreeable to him from a lew repetitions, and if it 
throws out a sweat. It quiets the erythysm of fever, 
and often under these circumstances, produces a solution 
of fever. Our custom has been to admit small quantities 
of cold water occasionally in every stage of fever, but 
most sparingly in the beginning. After the first stage 
of depression has passed by, the patient may take more 
liberally if desired ; and it may be observed, if mode- 
rately indulged in the first stage, there is seldom a neces- 
sity of very large quantities in the after conditions of 
fever. 

Acids and the common neutral salts are beneficial in 
the higher states of excitement. It will only be observ- 
ed, that the neutral salts of which nitre and cream of 
tartar are principally in use as alteratives, should be 
given in much larger doses, than is commonly practised 
in this part of the country. 

In the state of high excitement and febrile commo- 
tion, every thing that has a tendency to agitate the mind 
of the patient should be avoided. All husiness and every 
thing of a vexatious nature should be guarded against ; 



SECT. 111. TREATMENT OF FEVER. 20£ 

he should be soothed, quieted, and comforted by all 
around him. Whatever may act upon (he senses with 
any forte, should be avoided • such as much light, 
sounds, offensive smells, high heat, or painful impres- 
sions ; in short, what has been called the antiphlogistic 
regimen f should be strictly adhered to. 

Although epidemic diseases may be considered as 
of one family, and have many things in common, as 
respects their cause, symptoms, and method of cure, i( 
must notwithstanding be observed, that considerable va- 
riety prevails in their appearance, as respects particular 
characters, modified by a peculiarity of morbid influence 
inducing local impressions. In consequence of these 
varieties, and as arising principally from local affec- 
tious, different remedies become useful to suit such parti- 
cular habits of disease. A consideration of these must be 
deferred, and attended to under the particular diseases. 

SECTION III. 

On the third stage of fever, with exhausted excitement or 
indirect debility,* and other states. 

We will now, having attended to the two first of the 
primary considerations proposed, pass to the third,* and 

* The writer has had some hesitation, whether to employ 
this term, or substitute someother. His chief concern is to be 
rightly understood, and is little solicitous through what terms. 
Debility is used to express the torpor of the part before re- 
sponding action takes place, as, in the sudden numbness from 
cold; indirect debility is used to express that state which 
takes place after high responding action subsides by an ex- 
haustion of vital energy or irritability ; as in gangrene or 
death following a benumbed limb after inflammation. 



206 TREATMENT OF FEVER. CHAF. V. 

this is done for the purpose of making a few observa- 
tions only. Our indication remains the same ; it will 
therefore be considered a very broad one. In fact it is 
universal. Inequality of excitement is not confined to 
the sanguiferous system ; every part of the body may be 
warm, even very hot ; at the same time the absorbent 
and nervous systems may be dormant, or in a perverted 
condition. Health consists in a free exercise of all the 
functions. And furthermore, whilst there is a depraved 
action in the system, even if this is not attended with 
much distress, some of the delicate organs may suffer 
injury, or the integration of the fluids may be destroyed. 

The former condition of diseased action may have 
terminated in health, or in a state of convalescence, 
in which the physician has but little to do ; this may be 
considered as the most common event, when the ma- 
nagement has been judicious. But the case may be 
otherwise. Fever of a moderate type may continue, and 
yet exhaust the vital principle after weeks or months. 
It may continue for a much longer period, and in the 
character of some chronic disease, destroy some essen- 
tial organ, or impede and render useless such organs by 
collections of extravasated fluids. Therefore from fe- 
brile impressions being only partially removed, may 
arise what is called typhus, or continued fever, putrid 
nervous fever, &c. as also pulmonary consumption, atro- 
phy, mania, dropsies of the cellular membrane and of 
cavities, diarrhoeas, cuticular eruptions, &c. together 
with many more of those which have been called more 
particularly nervous diseases. 

It may be understood, that the previous observations 
on the cure of fevers in general have been intended to 



SECT. III. TREATMENT OF FEVER. 207 

apply to the more violent conditions of fever ; but this is 
not the most common form in which they appear. The 
access is often mild and deceptive. When the more vio- 
lent epidemics rage, a considerable proportion may be 
moderate, compared with those that are most violent. 

Again, it is often the case that the character of the 
hurtful principle in elementary diseases may be such, as 
most commonly to induce a fever attended with less vio- 
lent symptoms, as in typhus and intermitting fevers. 
Furthermore, the hurtful principle may be still more 
insidious and dilatory, and in conjunction with some con- 
stitutional liability, make an impression on the more 
delicate organs in the lymphatic vessels, &c. which pro- 
gress slowly, but unless removed, will destroy the system 
after a protracted and uncertain period. Examples of 
this are found in phthisis pulmonalis, dropsies,&c. which 
are not now considered as the sequel of fever ; foi* the 
primary changes were not so violent as to induce any thing 
more than a common cold or some slighter affection. 
These milder impressions and derangements are often 
very permanent, and eventually, though insidiously at 
first, frequently destroy the system, unless removed by art. 

If the impressions are violent and extensive, and the 
propensity to vascular action free and appropriate, high 
excitement and speedy termination will be the result; if, 
on the contrary, the changes are less perceptible and 
comparatively mild, and the lesions smaller and in a part 
less endowed with susceptibility of action, and in a sub- 
ject possessing less constitutional irritability, the symp- 
toms will be more mild, and the termination more 
protracted. 



208 TREATMENT OF FEVER. CHAP. V. 

By this climacteric view of the subject, we gain a fa- 
miliar, rational, and incontrovertible prospect of a great 
proportion of the diseases incident to human nature; 
and can trace, from the lowest grade to the highest step 
of morbid excitement, the various degrees of febrile ac- 
tion with their varied tendencies, and also apprehend a 
rationale of the various periods of termination in divers 
states of diseased action. 

Let us fix our attention more particularly, for a few 
moments, on that condition of fever, that is called putrid 
or gangrenous, which is said to occur more frequently 
at the fatal close of fever. It is noticed by some to oc- 
cur in those fevers that destroy life within the first day ; 
in others at the end of the first or second week; and in 
other cases at the end perhaps of four weeks, &c. It is 
seldom, that at these different periods the same iden- 
tical concourse of symptoms attend every case; but the 
general discriminative symptoms are present. Whoever 
will take the trouble to cast his eyes over the books of 
common place writers, will find that nearly the same, 
and all the principal symptoms are alike at the fatal 
close of the plague, yellow fever, spotted fever, pneumo- 
nic fever, angina epidemica, dysentery, typhus gravior, 
and mitior, &c. ; and whoever has had a view of the 
unfortunate termination of these and other fevers, must 
have noticed a very considerable proportion of the symp- 
toms present, that are said to denote a malignant or pu- 
trid state.* Even the spotted fever, that terminates in 

* The principal symptoms are, great prostration of strength, 
paleness, coldness of the skin, cold sweats, wildness of coun- 
tenance, partial loss of sight, very weak and quick pulse. 



SECT. III. TREATMENT OF FEVER. 209 

a few hours, shows a darkened colour in the petechias, H 
they happen to he present, and the patient has been said 
to be struck with mortification. 

Now it appears demonstrable, that all these symptoms 
arc the eonsequenee of high excitement, terminating in 
debility from excess of action, which may be called indi- 
rect debility ; and (hat the period of termination depends 
upon the degree of lesion done the system, and the par- 
ticular previous state of (he system of the person affect- 
ed ; — saying nothing at this time respecting the treat- 
ment. 

The distance of time from the commencement of the 
disease, when these symptoms take place, is of no conse- 
quence in a general point of view ; it may be sooner, it 
may be later. Those cases where reaction never takes 
place on the surface to any considerable degree, and 
which prove fatal during the first day, may be said to 
terminate by indirect debility \ for in all these cases, a 
vehement attempt in the heart may be discovered. The 
heart labours excessively to overcome the resistance, 
but this is so fixed that it is unable to do it. In these 
cases, although the greater part of the system remains 
dormant, or in a state of direct debility, yet the labour 
of the heart brings on indirect debility in that organ, 
followed by death. 

In such cases where the cause is violent, oppression 
great, rapidity in the pulse, &c. the termination will be 

starting of the tendons, sighing, &c. Oftentimes hickups, 
puking, involuntary stools, black tongue, difficult swallowing, 
petechia, purple colour, vibices, &c. See a simile, latter 
part of Serf. 1 . 

27 



218 TREATMENT OF FEVER. CHAP. Y. 

speedy; in such as are on the reverse of these, the ter- 
mination will perhaps he after several weeks; as in 
typhus mitior, &c. 

Our object ought to he to obviate these fatal tenden- 
cies by timely relieving the oppression of the heart and 
arteries of their burden, mitigating pain, stupor, deliri- 
um, &e. by evacuations proportioned to the exigencies of 
the ease ; also to invite a free circulation in the minute 
vessels for the purpose of saving the excitability or vital 
principle from exhaustion, the fluids from destruction, 
and the patient from death. These methods should be 
set about instead of stimulating the patient \>ith opium, 
calomel, wine, bark, alcohol, and all the alexipharmic 
round, with the same assiduity, that the inebriate clings 
to his fatal bottle. It is not doubted but that the patient 
may often need a little agreeable refreshment, suited to 
the delicacy of his condition ; but the practice of high 
stimulation is as preposterous and contradictory, as to 
apply ether to extinguish flame. 

AH fevers are disposed to show signs of debility and 
putrescency more or less in some one or other of their 
stages. The great secret of the Methodus Medendi is 
to turn this state of action into what is called phlogistic 
or sthenic more or less, and then reduce it to a healthy 
action by suitable and mild measures ; but it is not to be 
done by high stimulants ; they over-act the tragedy. 
Give freedom to the circulation by evacuations, suited to 
the condition of the case ; — excite the capillary system 
into universal action, by the remedies already suggested; 
support the stomach with agreeable refreshment in a 
liquid form ; and the patient is commonly safe, if early 
practised., 



SECT. III. TREATMENT OF FEVER. 211 

It is true when a person has advanced to this deplora- 
ble states lie is weak, and so he was the first hour of his 
sickness,* aud the cause has been gaining strength in 
proportion, as he has gr >w;i weak. If the cause had 
been weakened by suitable remedies his strength would 
have been gaining. Our observations have gone back 
With our views to the beginning of the ease, notwith- 
standing we set out to treat of the sequel, or last stage 
of the fever, ending in the deplorable state of indirect 
debility or putridity. We go back in an involuntary 
manner to take a painful review of the condition of the 
patient, when the most that we can do, is to lament, that 
we can do but litile now to save him. He may be sup- 
ported with the common cordials and tonics, peradveu- 
ture tiie last struggles of nature may, if no essential 
organ is spoiled, restore the system, like a convulsion, to 
health. 

Bark and wine, elixir vitriol, seneca, carbonic acid, 
lemon juice, malt bath, wine whey, broths, 6cc. may be 
tried according to the discretion of the physician. If 
they do no good, they may not do injury in a case already 
hopeless. — This distinction, however, may be kept in 
mind, that there is more hope of success in those cases 
of recent standing and rapid progress, than in those of 
more continuance : as secondary consequences or ravages 
in the system from diseased action, are not so great. It 
should be noted, that the above medicines are but rarely 
required in very large doses ; they are much safer and 
commonly more efficacious, exhibited in a gradual man- 
ner and accompanied with lenient cathartics and small 
portions of neutral salts. If the patient is not too greatly 



^12 TREATMENT OF FEVER. CHAP. V. 

exhausted a mild emetic will occasionally be very use- 
ful. Permission will be grauted lor one further observa- 
tion here, that those, who are attentively watching to 
obviate the much dreaded debility, are liable to resort 
to tonics and stimulants too early, and before the febrile 
diathesis is so far subdued, as not to be aggravated by 
them. This is a critical point. This paragraph may 
be finished with the suggestion; — that those cases which 
will not do well without high stimulants and tonics, are 
not very apt to do well with them. 

With respect to the management of protracted fevers, 
from the fashion of the day, called typhus, it will be 
necessary to see well to ii, that they arc removed in 
season. We have no excuse for want of time ; — we have 
no excuse, but that we are in possession of powerful 
remedies to alter the action of the system. Our princi- 
pal excuse, if any, is a want of judgment to apply them 
i ightly. Let the former indications be pursued ; — avoid 
high stimulants — supply the patient with light and agree- 
able food and drinks ; but be careful to remove the 
ilerungemeut in the minute vessels, for health cannot be 
restored, so long as any considerable vice exists there. 
Although the case may be so moderate, that the patient 
does not fall before it suddenly, or at the end of forty 
days ; yet it will consume him at length in the form of 
some chronic disease, if not removed. 

It should here be observed that in all protracted fevers 
and even those of shorter duration, if the patient has 
been suitably bled in the beginning, he will receive more 
benefit from the after bleedings than otherwise. 

Shock the system every twenty-four hours, or there- 



SECT. III. TREATMENT OF EEVEU. 21S 

abouts, with a mild emetic — keep the bowels open with 
mild purgatives, alternately with calomel and Glauber 
sails. It' a diarrhoea supervenes, be not too assiduous to 
stop it ; neither be too officious to staunch a purging of 
blood, that sometimes comes on ; this however is a rare 
occurrence, when sufficient bleeding is early practised. 

Keep the skin moderately warm, frequently to the 
sweating point ; use frictions, blisters, &c. By these 
is judiciously persisted in, the patient will be gra- 
dually gaining strength, and overcoming the disease } 
alarming symptoms will be avoided ; and also that train 
of chronic affections, which so frequently proves fatal. 
The objection that signs of debility forbid this practice 
is without foundation ; the true theory of the disease 
demonstrates, that it is debility of oppression, and verg- 
ing to the indirect kind from excess of action. Years 
of observation confirm this ; — as well may we say, that 
evacuations should not be made in pleurisy and apoplexy, 
because debility appears, 

Whilst penning this page the 3d No. of the 3d Vol. 
of the New England Journal is put into my hand, and 
turning over the pages hastily, a sentence struck my 
eye, which although contrary to the method adopted of 
quoting authorities, the desire can hardly be suppressed 
to insert. It is an observation of the Editor in the 
review of Dr. Thomson's Publication, on the subject of 
blood-letting: " We believe that new facts will shortly 
come before the publick in corroboration of these obser- 
vations ; and we can refer to several of our late num- 
bers for ample testimony in favour of bolder, and more 
decisive measures in febrile diseases, than the asthenical 



581* TREATMENT OE FEVER. CHAP. V. 

phantoms of a tottering theory have yet permitted the 
generality of practitioners to adopt. We shall con- 
clude this part of our review by a quotation from our 
author, with which we are much pleased." 

" There is therefore too much reason to suspect that 
the term debility, by which of late years every morbid 
symptom has been supposed to be explained, is a mere 
asylum ignorantice, into which the pathologist resorts, 
in order to conceal the defects, and the paucity of his 
knowledge," 

Observations, like these, are consoling to one, who 
has borne the heat and burden of the day. — Go on, 
dear sirs; and may your labours be instrumental in 
dispelling the clouds of errour, imposition, and medical 
sophistry, which have so long obscured and dishonoured 
the science of health. 

CHRONIC STATES OE FEVER. 

Our attention may be turned a little towards those 
diseases, that are considered the sequel of fever. If the 
derangement in the system is slight, made by the com- 
mon causes of fever and not removed, they become more 
permanent from continuance. If the first impression 
was more violent, and removed only in part, the case is 
similar to the one last mentioned. The fever in both 
cases remains, but not sufficient to destroy life after the 
manner of the diseases more commonly called fevers. 
Time is necessary for the morbid cause to develop itself 
in its true character. This will be diversified accord- 
ing to the most prominent local affection, and numerous 
other circumstances. 



T. III. TREATMENT 0* FEYElt. 21* 

It is common for universal and also partial dropsy to 
follow a rheumatic fever imperfectly cured. All have 
seen frequent instanees of pulmonary consumption, fol- 
low fevrs more particularly affecting the lungs: as 
after measles, influenza, &c. 

The numerous cases of adipose swellings, following 
canker rash, attended universally with quick pulse, arc 
the effects of the stimulating plan of cure: or a neglect 
of any plan in mild cases. These are cases of protract- 
ed fever. 

A peculiar state of chronic illness following spotted 
fever, may be mentioned here, and perhaps described 
under that habit of disease. This shows most distinct- 
ly a continuance of fever without inducing any other dis* 
ease of a characteristic nature, as yet to be discovered. 

It will be only observed further, that various transient 
indispositions appear, wherein there is a weakness, slight 
pains, rather frequent pulse, light furred tongue, im- 
paired appetite, &c. whilst the patient attends to busi- 
ness ; these have been called by some jaundice, by some 
gout, and by others debility. These indispositions are 
from a slight febrile commotion; they geuerally pass 
off without assistance, sometimes degenerate into trou- 
blesome chronic diseases ; but at all times, may be cured 
by the proper remedies. 

It may now be observed, that all the diseases, which 
are the consequence of fever, and which are believed to 
be numerous, are to be cured by the general remedies 
of fever. It is necessary that these remedies should be 
varied according to the locality of the disease — to the 
duration of it, and changes made in the system; to the 



216 TREATMENT OF FEVER. CHAP. V. 

age and strength of the patient ; and to the degree of 
excitement. 

Stimulants, antispasmodics, tonics, astringents, and 
the like, have been repeatedly tried for the cure of chro- 
nic pyrexial diseases ; but rarely with any success ; 
whilst the evacuating dcobstruent, and excitant plans, 
rarely fail, unless some organ is so far spoiled as to be 
irrecoverable — or the whole system greally depraved. 

An observation of some importance may be inter- 
posed here. The longer the derangement in capillary 
vessels has continued, the more difficult it is to be over- 
come. For example; those states of rheumatism, that 
have progressed into dropsy, and those states of influ- 
enza, that have progressed to ulceration of the mem- 
branes of the lungs, might perhaps have been removed 
by two or three bleedings in the beginning, with a few 
other appropriate remedies; but now in the condition 
mentioned, may perhaps require six or ten full bleed- 
ings to overcome them, with a proportion of auxiliary 
remedies; and also the first state might perhaps be re- 
moved in a week or two, whilst the last may require a 
month or two, or even more. 

REMARKS ON MERCURY AND OPIUM. 

It might appear sufficient for the present design to 
attempt to designate the remedies, that are useful in the 
cure of epidemic fevers, without adverting to those that 
are useless, or those that are hurtful, although much in 
fashion. This has been our design, and very tenaciously 
adhered to as yet. But there is one method of practice, 
which has become so general, and so obsequiously fol- 



SECT. 111. TREATMENT OF FEVEK. 217 

lowed, that it might be expected an opinion should here 
be given on the subject. The practice alluded to is the 
use of opium and calomel. But little more than an 
opinion v>ill be offered, with a few remarks. 

It will not be denied by the greatest advocates for 
their use, but that they are emphatically stimulants, and 
that the effect of salivation proves a stimulation of the 
salivary glands. Every one, that has noticed the ap- 
pearance of salivation in persons not affected with fever, 
must have observed an increase of the pulse in frequen- 
cy and hardness. The opinions of writers need not to be 
introduced to substantiate this. Perhaps there is no fact 
better established, and no subject in which physicians are 
better agreed, at the present day, than that opium should 
be set in the highest grade of the scale of stimulants ; 
and we may add, wheu given in any considerable quan- 
tity, produces a state of the system much resembling 
that attending what is called malignant fever; being a 
state of exhausted excitement or indirect debility. 

The position will be deuied, that opium or even mercu- 
ry stimulates the lymphatic more than the sanguiferous 
system ; with this exception, that after stricture is re- 
moved by other measures, mercury acts in a particular 
manner upon the salivary glands. Opium increases heat 
in every part of the system ; it stops perspiration, and is 
the most effectual of all remedies to cheek profuse sweats. 

If these positions are true, the first question that pre- 
sents is, whether these high and permanent stimuli can 
be admissible in those conditions of epidemic fever con- 
nected with primary derangements, which if the patient 
survives, are liable to be followed by high excitement, 

28 



31$ TREATMENT OF FEVER. CHAP. T. 

suddenly verging to a state of exhaustion, or indirect de- 
bility ? Patients may often survive a moderate disease, 
aggravated by improper treatment, but seldom a severe 
one. It is from a view of the aggregate, that just esti- 
mates can be made. 

We have maintained, that at the very beginning of 
fever, a direct debility is present, but have remarked at 
the same time, that this should be met with the lightest 
and most transient stimuli, and such as may not remain 
to influence the system when emerged from this state to 
high excitement, which is soon to follow, and in danger 
of going into indirect debility. A discreet use of opium 
might here be useful, if it were not for the circumstance 
of its leaving a permanent excitement in the system fop 
several days. But this effect is so blended with the 
symptoms of fever, that it is not generally discovered, 
nor is it generally admitted. 

Neither can this article be considered in a much more 
favourable point of view, in the more moderate and con- 
tinued fevers. The primary derangements are not re- 
moved by it, but the symptoms are aggravated ; — and 
although the event is at a greater distance, it is very sure 
to appear in an unwelcome aspect. If a person, that is 
well, should take a full dose or two of this drug, he may 
mark the consequences. A fever may at any time be 
brought on in a healthy person by repeating the dose in 
a proper manner. And again, let a person, that has not 
taken any opium, and is lingering in a slow fever very 
stationary, take a few doses, and a change may be dis- 
covered very readily ; he will have more fever, and an 
aggravation of symptoms, and it will take at least two or 



SECT. III. TREATMENT OF FEVER. 219 

three days tor the effects to be eradicated. Because an 
agreeable sensation is experienced most commonly upon 
the first exhibition of this drug, the patient, and often the 
physician, is induced to repeat it. Let this be as it may, 
it is asserted, and the assertion is founded upon much 
observation, that, with a very few exceptions, it is the 
most improper remedy in the materia medica for the 
cure of fever. By it mild cases are made formidable, 
and more serious cases are frequently rendered incura- 
ble. To prevent being misunderstood, it may be observ- 
ed, that in such conditions of fever of the lowest types, as 
require stimulants, opium may be sparingly employed; 
as in intermitting fever, &c. We have seen this how- 
ever changed into a continued fever with violent deliri- 
um, by a very little opium, given before proper evacua- 
tions had been made. 

In adverting to the use of calomel more particularly, 
it must be understood, that our observations are meant to 
apply to it when used as an alterant to affect the system ; 
but when used as a cathartic, and combined with other 
purgatives, it is often useful. 

It is believed that the use of mercury began in the 
East Indies, by salivation being found of service in chro- 
nic inflammation of the liver. Being useful in this, it 
was extended by its patrons to acute inflammations of the 
liver, and in fact, to all inflammations and fevers. Some 
flattering publications of its utility gained the attention 
of practitioners in the West Indies, in Europe, and in 
America. In a particular manner the attention of those 
was engaged, who were fond of subtile theories, and also 
of those who were fond of a mode of curcwhich appeared 



220 TREATMENT OF FEVER. CHAP. T. 

to supersede the necessity of thought. The mercurial ma- 
nia has spread like a pestilential influence, and we should 
be happy if it could be said with much less malignity. 

The theory of inducing a new action by the mercury 
for the pupose of destroying the morbid action of the 
fever, is one of (hose hypotheses, that look well enough 
on paper, but hardly reducible to practice. A patient 
will scarcely consent to have his foot scalded to relieve 
him from the distress of tooth-ache; if a blister or other 
irritants are applied to the nearest surface, their good 
effects are only transient. The theory is as absurd as to 
pile on a heavy burden upon an animal already staggering 
under a load too heavy for him to carry ; or to give a 
man a dose of laudanum to remove intoxication caused by 
drinking spirit. The human system was never able to 
bear these strong impressions, and has often sunk under 
them. In the milder kinds of fever the stimulus of mer- 
cury may be better borne, but here reason and experi- 
ence both instruct us, that instead of curing the disease 
" quickly and safely," it is protracted, and the event ren- 
dered more doubtful. 

It is asserted, by the advocates, if salivation can be 
excited, the patient is safe. If true, this does not prove 
that the lymphatic glands are opened by the mercury. 
If so, why does it so often fail when liberally exhibited 
with sufficient time ? All that is necessary seems to be to 
say the mercury cannot take effect, and therefore the 
case is incurable. The fact most generally is, that if the 
patient has ever so great a weight of mercury in his body, 
it cannot find its way through the lymphatic vessels, until 
the impermeability in the lymphatics is removed by the 



SECT. III. TREATMENT OF FEVEH. 221 

common anti-febrile methods, or by the efforts of nature. 
In this instance the mercury appears in the mouth, as a 
mark of relaxation in the emunctorics generally, which 
is a presage of returning health. The mercury docs 
not produce this effect; if it did, why should it so often 
fail ? It is presumed evidence will not be requested of 
its failure, if it should, enough is at hand. The fact 
needs to be supported by the advocates of this practice, 
that salivation renders the case safe. In various cases 
where the patient has been exercised with high saliva- 
tion, the event has proved fatal ! 

In mild cases, where it has passed in the mind of the 
physician and patient, that it has saved the life of the 
latter, it usually requires a longer time to get rid of the 
protracted mercurial fever, than might have been neces- 
sary to cure the original fever without it. 

One circumstance more will be mentioned ; when the 
cure is entrusted to the specific operation of calomel, 
other measures are generally neglected, which are of 
real service, and the time cannot be purchased that has 
been lost in mercurial speculation. 

Fevers are very apt to run into a chronic state, when 
treated with mercury, and are more difficult of cure in 
this state, than when such cases happen under any other 
management that we have even seen. Mercurial sores 
in the flesh, sore gums, intestinal discharges of blood, 
and mercurial hectic, which so often follow the practice, 
if the patient survives, begin to abate the zeal of its 
advocates, as it did ours seventeen years ago. 

It was thought advisable to treat this subject with 
candour : if any one wishes to see it mixed with bur- 



222 TREATMENT OF FEVER. CHAP. V. 

lesque, he is requested to peruse the tragi-comedy called 
the Mercuriad, printed at Lansiugburg, 1807. Man- 
court. 



With these introductory remarks, leave will be taken 
of the subject of fevers in general. It is expected, that 
these will shorten what might have been necessary to 
repeat on the several species of fever. It is hoped the 
reader will give them a patient perusal, and think, be- 
fore he judges. Although hastily and perhaps injudi- 
ciously arranged, it is believed, they contain principles 
which will s and the test of experience. 

Our attention will now be turned to some of the differ- 
ent varieties or habitudes of epidemic fever, or elemen- 
tary diseases. Some of these will be omitted, as not 
having come directly within the observation of the wri- 
ter; those that are introduced will be handled with his 
customary freedom. 






CHAPTER VI. 



ON SPOTTED FEVER. 



" In every blast the spotted plague be drives. 
While angry meteors ihoot across the heaven." 



SECTION I. 

History of the disease and symptoms. 

Having little anxiety what name is attached to any 
particular habit of disease ; provided the name does not 
influence the treatment, we shall not dispute about this ; 
and shall be as willing to continue it as any other ; and 
more so at this time, as every body knows what is meant 
by it. 

At the time of its first appearance in this country, it 
was called a new disease, and has been so denominated in 
other countries, where it never appeared before, or has 
been absent for a long time. A disease, however, bear- 
ing this name, and which we have undoubted reason to 
believe very similar to ours, is recorded in various coun- 
tries and periods. 

In A. D. 1505, it is represented as overspreading Eu- 
rope. In 1528, spotted fever again invaded Europe, fol- 
lowed by the plague. — And again in England and France 
in 1556. — And in Spain in 1557, as mortal as the plague. 
Spotted fever in many places in 1564. From 1569 to 



224 SPOTTED FEVER. CHAP. Vf. 

1574, the spotted or petechial fever prevailed in Europe 
with much mortality, and followed by the plague. Spot- 
ted fever at Trent, in 1591 ; — and in 1592, at Florence. 
— In Europe, in 1624. — In Italy in 1691 and 16 93. — In 
England, in 1698. — In Prussia, in 1704. — In England, in 

1710, and 1741.— In Piemont, in 1720 In Egypt, in 

1760. — It appeared at Geneva, in Europe, in 1805. 

A disease of this name has been discovered in some of 
the armies in Europe of late years ; at first it was taken 
for the plagae. The symptoms of the two diseases are 
very similar in many particulars. There is much reason 
to believe, that it has been considerably prevalent in Eu- 
rope, in modern times, where it has sometimes obtained 
the name of purple fever. 

Almost every practitioner in this country must have 
noticed eruptions on the skin, of various appearances in 
different fevers, which have a strong resemblance to some 
of the varied appearances which are noticed in what is 
more strictly called spotted fever. Sporadic cases have 
been considerably rife, and often the general term erup- 
tive fever has been applied, or petechial, or miliary. 
The appearance of these eruptions is sometimes modified 
by the treatment. 

The first notice of it in this country, which excited 
any alarm, was at Medfield, Massachusetts, in 1806. 
And again in Litchfield county, in Connecticut, in April, 
1807. It continued in Connecticut in different towns in 
1808 and 1809, &c. In the winter of 1809—10, it ap- 
peared at Worcester, in Massachusetts, and other towns 
in that state. About this time, and a little previous, it 
was noticed in different places in the state of New York, 
and also some in New Hampshire and Vermont 



SECT. I. SPOTTED FEVEB. 225 

It did uot appear in the state of Vermont to excite 
any considerable attention, until the winter of 1810 — 11. 
It may be observed, however, that for some time previ- 
ous to tliis, sporadic cases of fever often appeared, with 
unusual symptoms and much versatility of character. 
About this time it was prevalent in a very considerable 
number of towns in New Hampshire, the district of 
Maine, New York, Pennsylvania, and Canada. 

It continued in Vermont through the winter of 1810 — 
11, until the first of June. A few cases through the 
summer ; and in the winter of 1811 — 12, visited towns 
and neighbourhoods principally, that had been exempted 
the winter before. And since then has occasionally ap- 
peared in different places. 

This peculiar habit of disease seems to be generally 
the offspring of cold climates, and cold seasons of the 
year. With a few exceptions, it has broken out in the 
coldest seasons, and spread most alarmingly at such times 
in the different places it has visited. The months of 
January and February have oftenest given rise to it in 
point of season. When it rages considerably, it conti- 
nues perhaps to the middle of the month of Mayj and 
then passes off gradually like other epidemics. 

Whatever may be considered the cause, we find the 
subject which is attacked, possessed of an unusual degree 
of nervous mobility, or oscillatory state of action. 
This condition is manifested to exist in the living move- 
able powers of the system, by the great variety discove- 
rable in the mode of attack ; in the variety of symp- 
toms ; in the uncertain duration of the disease ; and in 

29 



226 SPOTTED FEVER. CHAP. VI. 

the rapid changes, which take place from one kind and 
degree of action to another. 

These circumstances obtain so effectually, that the 
disease can be said to possess a great versatility of cha- 
racter ; and we are at a loss for a set of discriminating 
symptoms to distinguish it by, unless we resort to the 
method taken by some of considering its eccentricity of 
character as pathognomonic of the disease. This, how- 
ever, is acknowledged to be too vague. It will be sug- 
gested in the shortest manner, that the disease may be 
distinguished more satisfactorily by a peculiar derange- 
ment in the physiognomy generally, than by any invaria- 
ble internal diagnostic symptoms. To a person a little 
conversant with the disease, and taking all circumstances 
into consideration, there will be no great difficulty in 
naming the disease, if any one is anxious about it, espe"- 
cially in the epidemic season. 

The most constant symptom, that has occurred to our 
observation, is a pain in the forehead between the eyes, 
similar to the pain that accompanies angina epide mi- 
ca. A great part of patients, that have the use of their 
reason, will either complain of this, or answer that they 
have it, in a short time after the attack ; or as soon as 
the fugitive nervous symptoms have a little subsided. 
This seems to be more depended upon in this place, than 
the soreness in the throat, which cannot by us be consi- 
dered any thing more than a part of the eruptive pro- 
cess, which is in itself uncertain, and our patients seldom 
feel so much in the throat as to complain of it. 

The first symptoms generally are extreme lassitude 
and desire for rest ; at the same time a sense of faintness 



SECT. I. SPOTTED FEVER. 227 

at the stomacb, with desire for food, which is often call- 
ed for with impatience. A coldness to the touoh is im- 
mediately discovered in the skin, and this last has some- 
times a purplish colour ; more commonly, however, the 
skin, at the attack, looks clear. 

In the less severe cases, there is often more or less 
cold chills 5 they are rather slight, and seldom spoken of 
as producing much distress. In severe cases, however, 
these are considerably distressing ; and in the most se- 
vere and dangerous cases, they are not felt by the 
patient ; as the reaction never obtains from this state of 
depression. For a simile of the more suddenly fatal 
cases, the reader is requested to see Chap. iv. Sect. 2. 

The access of the disease is at other times very sud- 
den. Without any previous notice, the system is thrown 
into great distress and pain in some part or other ; it is 
sometimes in the head, aud frequently followed by coma, 
or delirium ; or it may be in the back, side, temples, or 
some of the limbs. It frequently commences in the 
fingers, and spreads like an electric aura to the head, 
followed by great pain, with numbness, &c. The pain is 
often shifting from place to place. Sometimes it seizes 
the thorax, at other times the abdomen ; sometimes 
lancinating and transitory, sometimes obtuse and per- 
manent. In the head, when extending largely, it is 
attended with a throbbing or beating. One side of 
the body sometimes suffers more than the other; at 
other times, the pain is very small at the beginning of 
the disease, and such cases as become of a serious cha- 
racter after a little time, show nothing very alarming at 
the onset. 



228 SPOTTED FEVER. CHAP. VI. 

Some few are attacked with delirium, and run out of 
the house into the fields, and can only be restrained by 
superior force. Very commonly the sick would be inca- 
pable of describing their feelings from an imbecility of 
intellect or aberration of mind, and expire in a comatose 
state. At other times, the pain and anxiety would be 
such as the patient could not describe, and the distress 
would be manifested by moaning and weeping aloud. 

Sometimes, when the force of disease falls severely 
within the head, it is attended with more or less defect 
of sight and hearing ; a distortion of the eye produces 
double vision in some instances. The deafness some- 
times remains after recovery ; it denotes a severe disease. 

Convulsions or spasms sometimes usher in the disease. 
That form of tetanus, called opisthotonos, comes on some- 
times towards the close of severe cases ; it denotes an 
alarming case, but is not a fatal symptom. 

The countenance is generally placid, unless distort- 
ed by pain, with often a flush upon the cheeks ; as the 
disease advances, however, after a day or two, in such 
cases as prove fatal, the countenance becomes fallen, the 
features changed, and, in some instances, where they 
have been treated without evacuations and with high sti- 
muli, it exhibits a bloated appearance, of a dark sub- 
livid hue, with deep brown patches, and reddened eyes. 

The heat on the surface of the body is as variable as 
the other symptoms. The surface inclines to be cold, 
particularly in the beginning of the disease ; and also in 
the approach of paroxysms; notwithstanding a very 
high heat is sometimes observable, especially in the act 
of sweating. The eyes are generally dull and heavy, 



1ECT. I. SPOTTED EEVEB. 229 

inclining to shed tears without being conscious of it. The 
pupils incline to be large; these will sometimes contract 
and dilate alternately without, or with a very little change 
of light. A sublivid colour iu the under eve-lids. 

The tongue is commonly moist ; after some continu- 
ance of the disease, there may be some drought and de- 
sire for cold drink ; but little however is desired. The 
tongue is covered with a thin white coat. Sometimes a 
brown list appears in the middle ; this soon vanishes, and 
it assumes a red colour. The taste is generally correct: 
and refreshing food is often desired. 

The lungs are pressed with blood, but seldom any 
cough. Respiration is often laborious, and the patient 
inclines to be quick of speech. 

The heart, for a little time from the first sensation of 
lassitude and faintness, beats more slow and feeble. It 
is wont to remain feeble ; but in most of the severe cases 
it quickens with much rapidity, so that within an hour 
or two of the attack sometimes, from 120 to 160 pulsa- 
tions may be distinguished in a miuute; this rapidity 
does not generally obtain, until four or eight hours from 
the attack. In fatal cases the pulse increases in fre- 
quency, and continues to increase until nothing but a 
faint, tremulous, retiring motion is felt. Directly no- 
thing is felt at the wrist ; when at the same time, pulsa- 
tion may be felt under the head of the humerus. I have 
never known the pulse return with any advantage after 
retiring in this manner, with great frequency. 

The region of the heart is sometimes the principal 
seat of the disease, and not so violent in the head. When 
this is the ca«e, there will be an inexpressible anxiety 



230 SPOTTED PEVER. CHAP. tl. 

and inquietude from erythematic inflammation and pres- 
sure in this part. This is offered for a solution of many 
of the phenomena in this disease, which otherwise, would 
be unintelligible. 

The pulse is the index to show the variation of nervous 
energy in this disease, and it does it with considerable 
exactness. As the state of the system is vibrating, 
so the force and frequency of the pulse are very mutable. 
Notwithstanding the action of the heart is unstable, and 
pulse generally feeble, fluctuating, and compressible at 
the commencement; yet unless my judgment has repeat- 
edly deceived me, the action of the heart is often strong ; 
and the pulse considerably hard, full, quick and elastic. 
Some have said, that the pulse is deceptive in showing 
more strength, than the system possesses ; my observa- 
tions confirm me in the opinion, that there is more latent 
strength in the system, than is indicated by the pulse. 
On this conclusion is founded the proposed method of 
cure ; which will be considered in its place. 

The stomach is sometimes affected in a distressing man- 
ner, attended with pain and vomiting. This last, in some 
instances, is almost incessant, approaching to the condi- 
tion of cholera morbus; or rather that sort of belching 
great quantities of fluid, which sometimes affects dying 
people, especially such as have inflammation of the abdo- 
minal viscera. Although not a great proportion of cases 
are attended with vomiting, in those in whom it does 
happen, all the degrees of violence have been noticed 
from the mildest to the most severe, in different subjects. 

The materials ejected by vomiting, have not appeared 
under our observation, and in the first stages of the 



SECT. I. SPOTTED FEVER. 231 

disease, to be essentially different from what usually 
takes place in a person free from disease. First, the 
contents of the stomach : then a white viscid material 
more or less tinged with bile. "We have never been ap- 
prized of this last, being accessory to the disease, any 
more than the pancreatic juice, nor of its being mate- 
rially affected in the after progress of it. We have wit- 
nessed two cases where vomiting brought up a material 
very exactly resembling that described by writers called 
black vomit. These cases did not prove fatal. A like 
appearance we have noticed in vomiting in other violent 
diseases, in years past, some of which were fatal cases, 
and others not. From these reflections we are led to 
believe, this is not a fatal symptom. It is hoped the 
explanation of this symptom in Chap. iv. Sect. 2. will be 
satisfactory. 

Except the stomach, and some solitary cases of attack 
of the bowels, the abdominal viscera are but little affect- 
ed. The intestines are as little affected in this disease, 
as the head is in dysentery. 

The urine is but little changed, unless the disease is 
protracted considerably. Sometimes in the beginning 
there is a flow of pale urine. Strangury often attends 
this disease, after a few days from the attack ; but it is 
rather doubted at present, whether it is not oftener from 
the use of blistering, so generally employed, than from 
any thing necessarily connected with the disease. Or 
does the erythematic inflammation sometimes affect these 
membranes ? 

A very frequent concomitant symptom is an extreme 
soreness and tenderness in the muscles generally, and 



/ 



2S2 SPOTTED FEVEK. GHAP. VI. 

which supervenes most commonly after the extreme las- 
situde. In some cases, however, this soreness in the flesh 
comes on sooner. 

The joints are sometimes affected with swelling and 
extreme soreness, resembling rheumatism, but not at- 
tended with so much swelling. Sores in the cellular 
membrane have but rarely appeared, and when they 
have, were not large. 

Sweating could generally be brought on by external 
applications and very simple means internally. The 
sweats were attended with a peculiar smell ; rather sick- 
ening, emitting a mawkish sweet halitus, somewhat ca- 
daverous. They were not on the whole very offensive. 

The eruption, which has given name to this disease, 
is not a constant attendant, and has as great mutability 
in its appearance, as can be attached to the pathological 
character of the disease. The proportion of cases, which 
had distinct eruptions, may be estimated at about one 
sixth. Notwithstanding a considerable part of the re- 
mainder had some kind or other of cutaneous affection, 
greater or less, denoting them to be of the same family ; 
but this gives no discriminating character to the disease, 
as many cases occurred, in which not the least vestige 
of eruption could be traced. 

The second winter it prevailed here the eruptions were, 
not so frequent. The actual appearance of the eruption 
gives no relief. But its appearance along with other 
signs of excitement on the surface, may be considered as 
favourable. 

The eruptions appeared at different periods of the dis- 
ease ; perhaps most commonly on the second day. They 



SECT. I. SPOTTED FEVEK. 23$ 

sometimes resemble petechia;, or flea bites, as described 
by writers, happening in other diseases, of a dark hue ; 
sometimes of a brighter red colour. They are very nu- 
merous; of the size of a pin's head, or less. The red 
colour is most favourable. When numerous and of a 
darkened colour, aloug with a dusky appearance in the 
skin, they exhibit a very forbidding aspect. 

The eruption sometimes appears in blotches and 
patches of a red colour, and undefined in size, having a 
resemblance to divided portions of slight erysipelas. 
Oftentimes a less deep and more diffused erythematic 
appearance, and even a slight redness without any sort of 
elevation of surface. This appearance would occur very 
frequently on such parts, as were rubbed by the bed 
olothes, as the outside of the elbows, &c. 

Sometimes the eruption resembled the measles, at 
other times it was like small vesicles; and in a few 
instances there were very large vesications and few in 
number. In a few instances, these blisters contained ao 
ichorous matter. 

These eruptions were of uncertain duration ; slight 
and partial ones soon vanished. The true petechial were 
the most durable ; and in some fatal cases, which I had 
an opportunity of seeing, they continued for four or five 
days, and even until about the fatal period ; but they 
were not at all times equally conspicuous. In one case 
that had been abandoned as fatal, where the petechias 
were very numerous and dark coloured, of several days 
standing, they were turned to a bright red with tender- 
ness in the skin, by the warm bath with common salt 
dissolved in it; also by frictions and tonics, &c. The 

30 



23* SPOTTED FEVEK. CHAP. >1. 

patient showed signs of hope to all around her ; — pulse 
less frequent ; but the system was so depraved by the 
continuance of previous diseased action, that she died at 
the end of four days from the commencement of these 
measures. 

It cannot be required to notice all the anomalous 
symptoms, attending this disease ; they might fill a vol- 
ume. 

It assailed all characters and ages. The aged were 
the most exempt. The middle aged more liable to'it. 
And children the most of all. This disparity was revers- 
ed in the pulmonic epidemic, that followed the spotted 
fever, and in some places accompanied it. Very young 
children, however, were commonly exempt from either. 

The duration of the disease accorded with its irregular 
character. The most violent cases would sometimes 
end in twenty-four hours in ease and convalescence; 
which induced some people to think, that the physician 
had magnified the importance of the disease ; and caused 
them to doubt, whether they actually had the true dis- 
ease. Others would terminate in a low state of fever of 
considerable continuance. Again, the mildest cases per- 
haps, would be the longest, and the most likely to end in 
chronic illness. The common period of termination, was 
somewhere between the fourth and seventh day. 

It was very common for relapses to reeur, or for the 
disease to be repeated, after the patient had returned to 
his ordinary employment. In my third number on this 
disease, published in the public print, whilst the disease 
prevailed in this place, the first season, I find that the 
statement was, that in the last fortnight in March,whilst 



SECT. 11. SPOTTED FEVER. 23b 

thirty-two new cases fell exclusively to my charge, there 
Were also ten relapses in the same time, of those who had 
been well and about their usual employments. Perhaps 
the proportion was not much different at other periods of 
the season. 

SECTION II. 

Prognosis. 

With regard to the prognosis, it may be observed, that 
dark coloured petechia, deep coma, and a very quick 
pulse, either separate or as combined in the same case, 
denote a very dangerous disease. There is likewise a 
peculiar state of this disease, which sometimes obtains a 
stationary condition, not very alarming after the first im- 
pression has passed off, and in which the force of the 
disease is not sufficiently broken. In this condition there 
is a state not much unlike what Senac has described of 
the hidden nature of intermittents ; in which the disease 
is liable to assume a violent paroxysm and prove suddenly 
fatal. 

In no disease perhaps in the annals of medicine, have 
there been more recoveries from the most forlorn and 
hopeless condition, than in this. The extinction of life 
in some sudden cases bears a strong resemblance to syn- 
cope ; or to those spasmodic affections called hysteria.. 
In the first stages of the disease, it is all a nervous 
debility, spasm, and retroversion of action ; making al- 
lowance, however, for the injury that particular organs 
may receive in this sudden conflict, such as the brain and 
heart. These considerations should induce us to perse- 
vere o"- 1 baDe until the end. 



256 SPOTTED FEVER. CHAP. VI* 

SECTION III. 

Appearances after death, and on dissection. 

It may be necessary to take a short review of the 
morbid phenomena discoverable after death in the vic- 
tims of this disease. The motion of the blood in capil- 
lary vessels after death, makes some changes in the 
external appearance. "When spots appear on the face 
before death, or a darkened discoloration \ if the body 
is placed with the face uppermost, these discolorations 
diminish or disappear ; as also the redness in the eyes, 
whilst the most depending parts, such as the back, neck, 
sides, and thighs, become dark coloured ; sometimes a 
deep sublivid colour in large patches of irregular and un- 
certain dimensions ; the same is noticed in the back part 
of the lungs. With this resemblance to a state of morti- 
fication, there is no offensive scent, any more than in a 
person killed with lightning ; nor is there any evidence 
of a weakened texture of the fibres of tlie skin or mus- 



Soon after the disease appeared in this neighbourhood 
in the winter of 1811, I called one morning to see the 
body of a woman, who died of this disease after about 
fourteen hours* sickness, and who had been treated with 
emetics and stimulants. It was about two hours after 
death; her face* breast, limbs, and, I believe, the whole 
of her body, was variegated like the adder, with deep 
purple spots divided or bounded irregularly by the more 
natural appearance of the skiu. It is believed some- 
thing like this is frequent; indeed several other cases of 



SECT. III. .SPOTTED FEVER. 

this kind have come under my observation. But this ap- 
pearance, or a considerable degree of it, is frequently 
discovered in the attack of the disease, and the patients 
recovered afterwards, and oftentimes very suddenly. 

The muscles every where exhibit a full shade deeper 
colour than natural. The blood vessels in the brain, 
more especially the veins, arc very turgid. The small 
vessels are injected with red blood, which in a state of 
health are destitute of it. The membranes of the brain 
exhibit different degrees of inflammation according to the 
term of sickness and degree of local affection in the brain. 
Signs of inflammation are discoverable in almost the 
whole of the brain ; the dura mater adheres more strong- 
ly than natural to the cranium ; also the brain beneath 
often adheres to its meninges. An increase of serous 
fluid is often discovered between the membranes, and 
the ventricles are more or less filled with the same, as in 
hydrocephalus. The anterior and inferior parts of the 
brain exhibit the greatest marks of violence, and every 
where a remarkable pressure in the veins. 

The thorax exhibits very similar traits of membranous 
inflammation. The heart is most commonly the seat of 
its greatest violence, when the seat is in the thorax ; the 
small blood vessels seem beautifully injected. There is 
often on this organ and its appendages strong marks of 
inflammation. The outer coat is frequently covered with 
extravasated lymph of different degrees of consistence or 
firmness. This extravasation of serous fluid is some- 
times found in the cavity of the thorax. The blood, 
stagnating by numerous congestions in the capillaries, 
gives a dark colour to the muscles and membranes 
throughout the body. 



SPOTTED ILVER. CHAP. TI. 

As the thorax is not so generally affected as the head, 
so the abdomen is not so often the principal seat of dis- 
ease as the thorax. Notwithstanding the stomach and 
some of the organs most contiguous, suffer severely in 
some cases. When these organs are affected, they exhi- 
bit the same distension of blood vessels and traits of 
membranous inflammation, noticed in other cavities. 

It is noticed by all, who have communicated cases of 
dissection of bodies dying of this disease, that nothing has 
appeared in the course of dissection to induce a suspicion, 
that any thing like putrefaction had taken place. The 
dissections have usually been made within twenty-four 
hours. 

The following case occurred the 9th of April, 1811. 
The principal symptoms, as here noted, were given by the 
physician who attended, in presence of the family. The 
subject was a child 16 months old. It was taken with 
drowsiness, and slept from 4 to 6 o'clock yesterday after- 
noon, and when awaked, was still inclined to sleep ; vomit- 
ed six times in all ; sublivid appearance around the eyes | 
countenance pale, but florid upon vomiting ; small spasms 
and trembling in the muscles. The pulse from 6 o'clock 
was observed to be very quick, and considerably full, and 
continued so until about 12 o'clock, when it began to fail, 
and about 4 in the morning was extinguished ; at 6 the 
child expired, about 14 hours from the attack. A very 
few r scattering spots had been noticed. The physician 
estimated the pulsations to be about two hundred in a 
minute. 

Dissection began about ten hours after death. On the 
neck, back, and thighs, a general diffused, dark sublivid 



SECT. III. SPOTTED FEVER. 2dfl 

colour. The cranium was separated with some difficul- 
ty from the dura mater. Through all the membranes 
of the brain, a general turgescence of the larger veins, 
with a darkened colour; and also the smaller vessels ex- 
hibited a full injection. It was manifest that many of 
the vessels injected did not receive red blood in a state 
of health. About an ounce of water was discovered in 
the ventricles of the brain. 

In the thorax, the pleura, and all its duplicatures, that 
covered the organs, particularly the heart, and also in 
the peritoneal covering of the stomach, liver, and of the 
other organs in the superior part of the abdomen, were 
affected with the same sort of erythematic inflammation. 
The resemblance was something similar to a minute in- 
jection ; so fine and delicate that the eye could not trace 
them all, giving generally, the appearance of redness, or 
rather " an ill-looking purple colour." 

What was more curious, and attracted our attention in 
places less affected than the above, was the appearance of 
a vast number of spots dispersed in different directions at 
a medium about the size of acommon pin's head, of a red 
starry appearance. These spots were found on the ex- 
ternal and internal coats of the stomach, some of the 
superior parts of the intestines, and in other parts, as 
the diaphragm, and the organs in the thorax, where the 
other described changes were not so extensive and abun- 
dant as to obscure the whole of the natural appearance. 
They had a resemblance to the red petechias of the skin, 
only more distinctly stellated. The spots were more 
distinctly discovered upon the inner coats of the stomach. 
The appearance of these spots was not much unlike those 



2*0 SPOTTED FEVEU. CHAP. VI. 

which I have discovered formerly in dissection in the in- 
ternal coats of the large intestines in dysentery, after the 
hloody mucus was carefully scraped off. The stomach 
contained no ill conditioned matter, and hut a little of a 
similar viscid, mixed mattcr,which is common in suhjects 
free from gastric affection. One small worm was found 
iu the stomach, and two in the intestines. 

I was indebted for the following cases of dissection, to 
the politeness of Dr. Bowen of Reading, after having writ- 
ten the preceding. They are very important in two par- 
ticulars ; the first is, as they tend to show, that actual 
inflammation exists in the head even to the suppurative 
process ; the second is, that as four of them happened in 
the latter part of the winter of 1813, at the very time 
when a great number in the same town were affected 
with epidemic peripneumony, they seem to prove the affi- 
nity of the two diseases, and that the variation of symp- 
toms arose from the difference of locality. 

" Case i. Miss B. S. aged sixteen, was attacked with 
the usual symptoms of spotted fever in April, 1813. Af- 
ter the cold chills were removed, she complained of much 
pain in the head, for a few hours, when she fell into a 
stupor which continued two days, with great heat in the 
head: extremities cold and warm by turns. On the third 
day she had her reason, appeared to be better, but com- 
plained much of her head ; from this time she apparent- 
ly was on the recovery for three weeks, during which 
time, however, she constantly complained of pain in the 
back part of her head, frequently darting down her neck 
and back ; there was a constant heat in the part affected; 
the back part of the head sweat much of the time. Af- 



SECT. III. SPOTTED FEVER. %M 

ter four weeks she was evidently declining ; her memory 
and other intellectual powers, which had been weak ever 
since the first, were now approaching to idiotism ; soon 
after ihis she became comatose. A tetanic contraction 
of the muscles, &c. On the sixth week from the first 
attack she died. 

" Dissection extended no further than the head. On 
removing the scalp, the colour of the pericranium and 
bones was changed, and assumed that which usually 
appears after blows, when there is injury underneath 
from previous inflammation. On removing the bone, it 
was found, that the adhesion between the cranium and 
dura mater was almost entirely destroyed. In some 
places for an inch or two, they were perfectly separated, 
whilst in others they were only partially so. 

4 * There were but a few of those small red points to be 
seen, which usually appear so numerous on the inside of 
the removed bone, from ruptured blood vessels. The 
bone was dry, as was also the dura mater next the bone. 
The blood vessels of the brain were turgid. 

" The ventricles of the brain were crowded with wa- 
ter, and the cerebrum had the appearance of previous 
inflammation. On attempting to remove the second pro^ 
cess of the dura mater, well digested pus gushed out ; 
on examination, an abscess containing half a gill of pure 
pus was discovered. It was situated in the substance of 
the left side of the cerebellum, and extended down to the 
basis of the cranium to the great foramen. 

"The above was treated first with an emetic, then with 
stimulants, tonics, epispastics, &c. No calomel given 

31 



342 SPOTTED FEVER. CHAP. Yl. 

until within three or four days of her death, when it had 
no perceptible operation either on the glands or other- 
wise." 

« Case ii. A child of Mr. M. P. aged two years, was 
taken ill of spotted fever, in March, 1812, symptoms 
much as case 1st, in the first stage. After five weeks 
the muscular contraction, which before had been occa- 
sional, became fixed: viz. the thumbs we»e thrust be- 
tween the fore and middle fingers, the fingers drawn 
towards the ball of the thumb ; the hand towards the 
ulna or back part of the wrist. The toes towards the 
bottom of the feet, and these drawn backward. At the 
same time the head and sacrum were fast approaching 
each other. These contractions were all fixed, so that 
it was impossible to straighten one of them. 

66 The child now lost its hearing and sight, with dilat- 
ed pupils ; the fever now assumed the hectic form, with 
some cough ; the cold and hot stages very severe ; flesh 
fast wasting ; and at the end of three months it died, 
horribly distorted and greatly emaciated. 

" Dissection. The lungs rather darker coloured than 
the healthy, with some frothy mucus, but not ulcerated, 
and sufficiently inflated; the heart, stomach, liver, bow- 
els, spleen, &e. all natural. The cranium, dura mater, 
&c. similar to case first. The ventricles full of water, 
and so far as I could discover, from the soft substance 
of the brain, they were burst from pressure. The wa- 
ter extended down the medulla spinalis, where it had 
formed a sac on the two first vertebra of the neck. The 
water yellowish, similar to that discharged from a 
blister. 



SECT. IV. SPOTTED FEVER. 24S 

♦•Treatment. An emetic on the first day; on the 
third a large dose of senna and sulphate of soda; after 
the operation of which, it eanie to its senses; — otherwise 
With diaphoretics and stimulants." 

" Case hi. Died at the end of sixteen weeks; appear- 
ances similar to case second, except the water extend- 
ing so far as the spine." 

«« Case iv. Similar, &c. at ton weeks." 

" Case v. Similar to case first. The collection of 
pus near the ceutre of the cerebellum; died 4 at the end 
of seven weeks." 

"Case. vi. Died in twelve hours after the attack; 
aged twelve years. The lungs dark and spotted. The 
cranium and dura mater adhered firmly ; the membranes 
suffused or congested with blood, as was the whole sub- 
stance of the brain. Indeed the contents of the crani- 
um appeared as different from the healthy, as an inflam- 
ed eye does from one not inflamed : a little water in the 
ventricles, not much more probably than in health. 
November 18th, 181*." 

The last case is also important in proving the exis- 
tence of spots in the membranes of the viscera in the 
first stage of the disease. It is considered parallel 
to the case of my own dissection above ; and establishes 
the existence of an important phenomenon. 

SECTION IV. 

Pathological Reflections. 

The bold and gigantic features of this disease are cal- 
culated to arrest the attention of physicians; to develop 



244 SPOTTED PRVER. CHAP. VI. 

the principles of medical philosophy ; and to call forth 
the highest energies of the human mind to divert the 
force of the disease from its intended victim. "Whilst it 
has swept, like a torrent, many from existence in the 
northern states of America, it has also carried wilb it 
to be ingulphed, in the whirlpool of oblivion, some of 
the visionary and crippled theories of the old schools of 
medicine. Century has passed after century, whilst a 
part of physicians have been satisfied with the " tales of 
other times,' ? and iu looking with horror for a commu- 
nicative contagion in epidemic diseases, have shown less 
zeal for humanity, than for that of personal preserva- 
tion. Aud also, the writings of the dark ages of the 
world have been appealed to in the collection of opinions 
to serve as precedents, and almost every symptom of 
epidemic diseases Marped into proofs of a humeral pa- 
thology, and the existence of a fermenting principle in 
the blood, inducing putrefaction. 

At the time that the physicians of America were 
engaged in the support of a mode of reasoning and in- 
ductions very different, in several respects, from many 
of those of the eastern countries, the disease under con- 
sideration, by its prominency of character, appears to 
decide the controversy. All the symptoms and circum- 
stances of the disease warrant the conclusion, that the 
primary fault is in the nervous and moving powers of the 
system ; and also that the remedies ought to be directed 
to the regulation of morbid excitement, and the restora- 
tion of healthy action; expecting the fluids will harmo- 
nize accordingly. 

If any fever can with propriety be called nervous it 
ought to be this. For the motions of the system, in the 



SECT. IT. SPOTTED FEVER. %^h 

more distinctly marked cases, are rapid and transitory 
almost beyond example; or if the disease does not end 
fatally sooner than some other diseases are known to do, 
yet it is attended with manifest signs of nervous affec- 
tion, more distinctly marked perhaps, than in any other 
form of epidemic disease. 

Besides the symptoms previously noticed, the greatest 
evidence of spasmodic, or emphatically nervous state of 
the system, is discovered in the mobility and irregularity 
of the motion of the heart. It is prone to be irregular : 
sometimes excessive, sometimes deficient. The heart 
acts spasmodically whilst there is stricture or cramp in 
the capillaries, and signs of spasm in other parts. 

It will of course appear, that if a qualifying word must 
be added to this disease, the word, nervous would be 
more appropriate, than that of malignant. If this last 
is used to express merely an aggravated, or high state 
of febrile commotion, there would be little objection to 
its use ; but if it is used as synonymous with putrid or 
pestilential, or to express any particular quality of dis- 
ease, its use is very objectionable. Possibly the word, 
ataxic may be more technical and more agreeable than 
nervous, to express the incoherency of action in this 
disease. 

As we see injuries done to the external parts of the 
body by wounds, bruises, burns, &c. attended with great 
diversity of symptoms according to the degree of lesion, 
the part affected, and the personal susceptibility of the 
subject, so impressions of unequal force upon the sur- 
face and different internal organs, variously affecting 
the sensorial power, exhibit a vast diversity of syrap- 



246 SPOTTED FEVEfl. CHAP. VI. 

toins and appearances in different states of fever. Not- 
withstanding, all these diversified appearances may be 
resolved into one principle or law of the animal econo- 
my, called irritability, or a capability of responding to 
the force of irritants ; and excitement or action more or 
less inordinate follows. 

Agreeable to our theory previously advanced, it will 
appear, that the predisponent influences have a particu- 
lar effect upon certain internal membranes, rendering 
them exquisitely liable to congestion and inflammation. 
The membranes of the brain are particularly prone to 
inflammation in this disease ; also the heart frequently 
and other organs in the thorax, &c. as before stated. 

This membranous affection is termed inflammation ; 
but it must be understood as very different from phleg- 
monic inflammation : the part is scarcely thickened. It 
is not strictly erysipelatous. It seems to be interme- 
diate between what is called erysipelas and erythema. 
The diseased affection appears to follow considerably 
the course of the blood vessels. It has a resemblance in 
many respects to the cutaneous eruption in the same dis- 
ease, both as it appears in spots and in diffused inflam- 
mation, with distension of blood vessels internally. It 
may more properly be considered an inflammation sui 
generis. 

The particular condition of this internal inflammation 
is varied, and modified by circumstances ; it is often dif- 
ferent in different habits ; sometimes more phlogistic, 
affording a dense fibrinous exudation upon the surface of 
the organs; at another time, a more dilute effusion of 
an ichorous appearance j and sometimes more approach- 



SECT. IV. SPOTTED TEVER. CiT 

in" to a sort of purulent state. In recent cases, or those 
which terminate fatally in a short time, no gelatinous 
exudation may he discovered \ nothing hut mere inflam- 
mation, with an aqueous effusion in the ventricles of the 
brain. 

The cutaneous eruption seems to he a sort of sympa- 
thetic echo, or reverberatory reflection of the internal 
affection, liable to be diverted by accidental circum- 
stances. 

Internal membranous inflammation is not peculiar to 
this disease ; it is believed to occur very constantly in 
some internal part, in all elementary fevers of any 
considerable importance. In the milder and more pro- 
tracted states of fever, it is not so readily distinguished, 
but is always present in a greater or less degree. It is 
of different varieties in different epidemics ; sometimes 
more strictly phlegmonic and circumscribed. 

From a very susceptible condition of the parts, induc- 
ed by the predisponent causes, congestion and internal 
inflammation proceed very rapidly in the high state of 
nervous susceptibility and febrile action accompanying 
this disease. The circumstance of this internal affection 
merits a particular regard in the pathology of the dis- 
ease, and also as respects the treatment. The more fix- 
ed the stricture in the capillaries of the surface is, the 
more are the internal membranes liable to suffer by con- 
gestion and inflammation. The sooner and more effec- 
tual the derangement in the surface and capillaries can 
be removed, the sooner and more complete will be the 
dissipation of the internal congestion. Hence it is that 
we see cases of epidemic fever suddenly cured by a re- 



2*8 SPOTTED FEVER. CHAP. VI. 

moval of the primary derangement ; provided, this can 
be effected before reaction has become violent, and in- 
duced secondary consequences. And again, we see fever 
continued very frequently after the cutaneous derange- 
ment seems to be restored. Fever, in this instance, 
seems to be supported principally by the internal mem- 
branous inflammation. 

SECTION V. 

On the treatment^ or methodus medendi. 

After what has been suggested in this, and the three 
former chapters, the method of treatment will be com- 
prised in miscellaneous facts and observations. 

Although we may have a primary object in view, yet 
it must be acknowledged, that in a disease attended with 
a versatility of appearance as the one under considera- 
tion, no one particular method of treatment can always 
be pursued. Perhaps this may be said of all fevers ; 
and if so, it may emphatically be observed in this. Not- 
withstanding, the cardinal objects should be kept in 
view, like the pointing of the mariner's needle ; and the 
unstable and vacillating symptoms regarded as pressing 
currents and tumultuous gales, which merit attention 
for the time present, but must not be permitted to divert 
the course from the desired haven. 

Like the spreading of other diseases of considerable 
fatality, public solicitude had preceded this, in this part 
of the country. The natural queries were, what has 
been done for its cure ; and what are the best remedies ? 
The only answers were, opium, brandy, ardent spirits. 



SECT. V. SPOTTED FEVEK. 240 

wise* sweating* and the whole round of the alexipharmic 
regimen. These were published as the best remedies, 
in various newspapers; and at the same time cautions 
against any evacuations, especially bleeding. This\icw 
of the subject hud become very generally received by the 
public, and by physicians, who had not seen the disease. 
It was considered as a very extraordinary disease, not 
subject to the usual control of remedies ; but medicine 
of Herculean strength must be administered. All was 
mystery. 

The name of the disease was sometimes more dange- 
rous than the disease itself; for as soon as it was called 
spotted fever, every thing, like the above, was put in re- 
quisition ; and the principal care seemed to be to get 
down euough stimuli. Soon after the disease appeared 
here, I was called several miles distant to advise in a 
case of a middle-aged athletic man, taken with the dis- 
ease about nine o'clock in the morniug. I arrived at 
about five in the afternoon ; he was senseless and expir- 
ing, with a full strong pulse, which beat between one 
and two minutes after every other appearance of death. 
The physician, a reputable man, had been with him from 
about twelve o'clock. Upon asking hew much opium 
had been taken ? it was answered, several doses ; and 
how much spirit ? it was said considerable, as much as 
could be got down. 

The above is only put as a specimen ; the same senti- 
ment generally prevailed, and it was thought almost mal- 
practice to neglect the ahove measures in (heir fullest ex- 
tent, or to practise bleeding, or even other evacuations, 
without the greatest caution. 

32 



250 SPOTTED FEVER. OHAP. VI. 

Having a preconception of the possibility of public 
opinion being liable to errour in matters recent and ab- 
struse ; the determination had been formed in my own 
mind to investigate the character of the disease, upon 
physiological principles, as far as I was capable, without 
regard to names or received opinions. Accordingly, the 
first cases were watched and scrutinized with care and 
solicitude. The opinion then formed remains satisfac- 
tory to the writer at the present time, and even more so, 
having stood the test of experience. 

The principles, as connected with this opinion, have, 
in part, been detailed in the previous chapters, and in 
part, are to follow in this. It is particularly requested, 
in this place, that the generous reader will keep in mind, 
that the principles of medicine are aimed at, and nothing 
is intended to be levelled at the reputation of individuals. 
Man is on a level with his fellows in one respect, at least; 
which is, that he is liable to err. Benevolence reacheth 
forth the mantle of charity to cover the foibles of an 
honest brother. And where is he that needs it not ? It is 
our lot to differ in sentiment from some of the gentlemen 
who have written on this disease, and whose remarks 
have come to hand since the appearance of it in this 
place; but little will be attempted in refuting them. We 
would rather give due honour to the merit attached to 
them, and consider them as very useful to the commu- 
nity. It is possible, that the first cases in some places, 
at the beginning of the epidemic season, discover more 
distinctly the spasmodic or nervous symptoms, than per- 
haps the after cases do. But this we are sufficiently 
established in, from a personal knowledge of diseases in 



SECT. T. SPOTTED PEVER. 251 

all the New England states, more or less, together with 
the varieties of practice, that the stimulating method 
of' treatment is too much adhered to in general, not only 
in epidemics, but in other pyrexial chronic diseases. 

In speaking of stimulants it is to be understood, those 
of the higher kind internally exhibited. We mean to 
advocate the use of external stimulants in all cases con- 
nected with low action ; the principal of which is heat. 
And tliis will be first considered in this disease. 

Perhaps no single remedy is better agreed on among 
physicians as being generally useful, in this disease, than 
sweating; or, iu other words, the application of external 
heat. If it is not always useful, it is in some solitary 
cases, where there is an abundant heat from reaction 
having taken place in vigorous habits. At the onset of 
the disease, however, this remedy may be said to be al- 
ways useful. 

From what was suggested in Chap. in. Sect. 5. and 
Chap. iv. Sect. 3. relative to the weaker energy of the 
surface compared with the incarcerated viscera, it will 
appear how important it is to restore warmth and vigor 
to the surface. We have been so thoroughly impressed 
with this important fact, that for a number of years it 
has been our constant practice to use diligently the warm 
bath, steams, ccc. in the various epidemics that have in- 
fested this portion of the couutry, such as typhus fever, 
dysentery, peripneumony, all the variety of colics, &c. 

Where there is a deficiency of heat, there is a defi- 
ciency of excitement ; and a deficiency of these induces 
temporary debility. In all these cases, restoring heat 
restores vigor. Tt is of the first importance, therefore, 



252 8P0TTED FEYKR. CHAP, VI. 

that warmth be applied in (he great prostration of 
strength connected with tliis disease. It is of indispen- 
sable use in the nervous stricture on (he surface in re- 
calling life and energy back to the skin, and in estab- 
lishing the ai'tion of perspiratory organs. External 
warmth is of vast importance in keeping up the centri- 
fugal action of the system. If the action is allowed to 
recede to the centre, by neglect of external warmth, af- 
ter sweating has been used with advantage, the patient 
is apt to be exercised with sinking, distress, &c. and will 
be iu danger, if heat is not immediately applied. It is 
very curious and pleasing to see how suddenly and effec- 
tually relief will be obtained in many cases without the 
aid of internal stimuli. 

Heat is the safest and most congenial stimulus, that 
can be used for the cure of all diseases, connected with 
external deficiency of action; and these comprise three- 
fourths of the whole nomenclature of diseases. By defi- 
ciency of action is meant, such diseases as commence 
with great torpor. It is true, that after the system is 
roused into vehement responding action, much heat will 
be present, in many states of disease ; in such cases there 
will be no need of applying heat ; but even here the tepid 
bath is often agreeable and useful. 

A consideration of still higher importance, if possible, 
is, that by diverting action and pressure from the inter- 
nal inflamed membranes, these are relieved of their bur- 
den in a great degree ; and if the disease is not violent, 
may be cured by this remedy. If it is a violent case, it 
relieves in part, and assists the cure. Other considera- 
tions of its utility will be passed over for the present. 



SECT. V. SPOTTED FEVER. 253 

The application of heat and sweating have their 
limits, like all other remedies. No remedy is useful 
only lo ■ certain extent; that is, when the ohject is ob- 
tained for which it is used. The first ohject is to re- 
store warmth and action ; the next is to support them. 
Warmth may he used freely until the first is obtained, 
after this it must be conducted with much discretion ; 
only sufficient to keep action upon an equality as much 
as possible. Several cases have been noticed in the dis- 
ease under consideration, where too great a degree of 
heat and sweating threatened the existence of the pa- 
tient. In these cases, as Dr. Woodward observes, «•' cool 
air, a cool room, and cool bed, are very refreshing." 

The manner of applying heat must be guided often- 
times by circumstances. A preference is given to the 
warm bath ;* but this is often inconvenient, and would 
often require too much time in the preparation. Blan- 
kets, dipt in warm water, and applied over the whole 
body, is a substitute, and, in some respects, has the pre- 
ference on account of being continued for any length of 
time. After the patient is enclosed in one bed-blanket, 
a second may occasionally be dipped again and kept 
w r arm. Steams may be used sometimes to advantage. 
Billets of wood taken from boiling water. As soon as 
the sweat flows, it may be sufficient to apply dry blan- 
kets and a few dry substances made warm. When action 
is considerably established on the surface, a sufficiency 
of bed-covering will continue it. 

As a means of promoting warmth and vigor upon the 
surface and system in general, internal stimulants may 

* See note in Chap. v. Sect. 1. concerning Jenning's apparatus 



:2.ri SPOTTED FEVEK. GHAP. VI. 

be had recourse to. But here it will be observed, we 
have to differ in many respects from respectable bre- 
thren of the faculty. Instead of the higher and more 
powerful stimulus of opium, brandy, &c. without mea- 
sure; we recommend, with a few exceptions, hot infu- 
sions of aromatic herbs, seeds and roots ; occasionally 
agreeable essences and warm water; a little wine made 
moderately warm, or a little spirit with hot water and 
sugar. Also seneca, ginger, cayenne, &.e. The most 
agreeable stimuli should be sought for, and such as are 
of a diffusible and transient nature, as described in 
Chap. v. Sect. 1. 

It is very much doubted, whether stimulants of the 
highest kind and greatest quantity, will restore vigour 
upon the surface, in the prostrate state of this disease, 
before they are liable to induce, by their irritating influ- 
ence, irreparable injury in the internal organs. They 
are rendered more safe when accompanied with external 
warmth. When aided properly by this, the more mild 
stimulants are commonly sufficient. To prevent being 
misunderstood, it will be asserted as an opinion, founded 
upon observation, in seeing the trial of high stimulants 
in certain cases, that the chance of success is much 
greater, by the use of mild stimulants and external 
warmth, than by large doses of high stimulants with or 
without external heat. 

An almost certain fatality has attended the use of 
large quantities of high stimuli in severe cases, in this 
quarter; and it is believed the features of the disease 
have been very similar to those of the disease in other 
places, where high stimulants have been supposed very 



SECT. V. SPOTTED FEVER. 25 b 

beneficial. In cases reported to be cured by high stimu- 
lants, it is suggested, that more benefit has been gained 
by external warmth accompanying their use, than by 
the stimuli. High stimulation is rendered much safer 
when connected with external heat, than otherwise; 
their force is more likely to be dispersed to the extreme 
parts of the body, and diverted from the internal organs. 

When stimulants internally are used in the case of 
low fever, if they are not so managed as to excite action 
on tbe surface, they are apt to quicken the pulse, in- 
crease pain and exhaust the vital principle. But if 
managed so as to have this desirable effect* may be 
useful in moderate doses. Therefore, if a patient gets 
stimuli in this condition, he ought to receive along with 
them a permanent use of external warmth, conducted in 
such a manner as he is able to bear ; rather in an agree- 
able manner; and he may receive benefit from them, 
unless the degree of internal stimulation be greater than 
is compatible with his personal condition. 

A familiar instance may be noticed, relating to the 
use of stimulants, whilst torpor prevails on the surface, 
in confirmation of the positions just now advanced. Let 
a person in health be exposed to severe cold for a con- 
siderable length of time, and perhaps with labour; give 
such an one his customary dram of spirit, and let him 
continue in the cold, he will feel an unusual effect from 
the spirit ; he will even appear intoxicated ; and many 
have been lost in passing their way alone afterwards. 
In this case the internal stimuli cannot diffuse action 
upon the surface and capillaries; its force is spent in 
the internal parts, and coma is produced, &c. In like 



256 SPOTTED FEVER. CHAP. VI. 

manner, the internal stimuli, disconnected with the ex- 
ternal stimulus of heat, are pernicious ; and it would 
gladden our heart, if we could say, they were always 
harmless under the most favourable circumstances. 

It is a well known fact, that people in health bear the 
operation of high stimuli, such as opium and ardent 
spirits, much better in a heated room, or heated bed 
with perspiration, than when exposed to the common 
temperature. They are not so readily intoxicated in 
this condition ; but this does not prove but that they may 
be hurt by them, even under these circumstances. As 
there is a great degree of torpor, or temporary depres- 
sion in the system generally in the attack of this dis- 
ease ; and as in the cases reported of great stimuli being 
used without intoxication ,• and as it is believed, that ex- 
ternal heat and sweating have been practised at the same 
time ; may we not infer that intoxication has been pre- 
vented, in part, by this circumstance ? Considering the 
great quantity of medicaments required sometimes to 
move the system under certain circumstances, the use of 
large stimuli might be more justifiable, if their hurtful 
tendencies could be averted. However this may be, it 
is believed that this fact remains, that all cases, at all 
times, have not terminated so favourably, as some that 
have been reported. 

All epidemic fevers require more or less external and 
internal warmth, in the first hours of the attack; but as 
this is a disease showing great disparity of action in dif- 
ferent stages, so in the first stage, the prostration of 
action often demands a pretty liberal use of the means 
necessary to bring back an equality of excitement. It 



SECT. Y. SPOTTED FKVF.U. 257 

may here be observed, tliat it is of great consequence to 
be assiduous in promoting equality of excitement ; not 
only as it respects different parts of the system ; but also 
as it respects the diseased action generally compared 
with the healthy state. 

These measures will prove more beneficial, if we can 
keep our judgment from too great a preponderance to 
any particular preconceived plan, to be followed in all 
circumstances indiscriminately ; and as soon as heat and 
action are eliminated to the torpid veins and lymphatics, 
we suppress excessive energy by venesection, and other 
sedative measures. 

To conclude this part of our subject relating to the 
use of stimuli in fever, a short extract will be taken from 
Dr. Wilson, which seems to be the same, as I had formed 
from observation more than fifteen years before the 
book came to baud. It will apply in the present ease. 
" The feeble state of the circulation and the temporary 
good effects of powerful stimuli, have led most physi- 
cians, and particularly those of later times, to employ 
them with great freedom. Many, however, confess, they 
have been disappointed in their effects ; of this number 
I can feel no hesitation in declaring myself to be one. 
I have found the second stage of fever most tradable, 
when all 'powerful stimuli were avoided" Vol. II. p. 585. 

If our views of the disease are correct, it will appear 
that the internal vessels are prone to congestions, espe- 
cially in the head, and the heart is oppressed with a re- 
percussion of humours, &c. Under these circumstan- 
ces, the important question of the propriety of blood-let- 
ting is brought up. The use of this remedy has been 
strongly opposed, and but little advocated. Although 

33 



258 SPOTTED FEVEK. CHAP. TI. 

our confidence of its utility, under certain circumstan- 
ces, is unshaken ; yet from the weight of opinion against 
it, the subject will be approached with diffidence. After 
the general observations already made, but little argu- 
ment will be advanced, but reliance placed chiefly upon 
facts. 

In recent cases, before that state of the system occurs, 
called by some the sinking state, there is almost always 
a struggle in the heart and arteries to overcome the 
oppressing powers. The heart acts with some force at 
this time, although it cannot be great ; it needs relief. 
In severe cases the time is short, and should be well im- 
proved. If external warmth is applied, the patient in a 
recumbent posture, and attended with much pain, or 
lethargy, he may be benefited by bleeding ; and under 
these circumstances may probably be prevented from 
going into an irretrievable condition. By this the pain 
is mitigated, the pulse enlarges, and sweat flows more 
readily. 

A case will now be stated. To show the reality of 
the disease, it will be first stated, that two lay dead in 
the house. One a young woman not my patient. The 
other a little boy about five years old, to whom I was 
called early the morning before. He was in great dis- 
tress ; sinking, and almost ready to expire. As emetics 
were extolled by some, in this situation, I was induced to 
give him, though reluctantly, a small dose of ipecacuan- 
ha, which I have ever since regretted. As he vomited 
he took a dose of laudanum. He died in about an hour 
and a half after I saw him, and in about three from 
waking in the morning. This was but a few days after 
the sickness began in this place, and about the first of 
February, 1811. 



SECT. V. SPOTTED FEVER. 259 

The next morning another boy about eight years of 
age was taken, in very similar circumstances, at the 
same hour of waking. As the family expected nothing 
but sudden death, I felt at liberty to treat the c^.se with 
freedom. The warm bath was ordered. Whilst this 
was preparing, observing his pulse to be very rapid and 
small, giving the sensation of a little sharpness ; believ- 
ing it must soon fail as did the other, I resolved to give 
Tent to the blood without waiting a moment for the bath, 
wishing at the same time that this might be first used. 
He had extreme pain in his forehead, a crimson flush in 
his cheeks, a sublivid colour under his eyes, flaccid veins, 
dry skin, with constant writhing, whilst held upon the 
knees of another person. About five ounces of blood were 
taken from his arm. He said immediately his head was 
easier, he sat more quietly. No signs of sinking attend- 
ed this operation, as the strength of the heart was not 
yet prostrated. 

He was now immediately immersed in warm water; 
he expressed its being agreeable to him, although he had 
no cold chills. After remaining about ten minutes in 
the bath, he was laid into a warm bed, with billets of 
wood placed around him from boiling water. These 
were afterwards changed for dry substances. A free 
sweat was soon induced, and his pulse became more full 
and free with less frequency. In about five hours I was 
sent for in haste to see him, when I found the nurse had 
pressed the sweating too freely, and he was much op- 
pressed with heat. The bed covering was loosened, 
cool air admitted into the room, when he was soon re- 
lieved. Notwithstanding he was manifestly changed 
from the state of immediate depression, his case was 



260 SPOTTED FEVER. CHAP. VI. 

considered desperate by all who saw him ; but hope, 
gleaming from a distance, inspired me with confidence. 
I now resolved to spend more time with him; and the 
principal part of the following night was spent iu attend- 
ing to every symptom, particularly the pulse. He took 
but little medicine except light cordials, such as essence 
of peppermint, spirits of lavender, &c. with coffee, tea, 
&c. as he seemed to need them ; with sage and balm in- 
fusions, &c. His pulse grew more free and less frequent 
after the sweats had continued twelve hours ; the sweats 
had been kept free but not large, with little more than 
common covering, ever since his being relieved by loos- 
ening the clothes. 

At about break of day, the time he was attacked the 
morning before, I perceived his pulse began to fail ,• but 
they were not so frequent by about thirty strokes in a 
minute as they were the first morning. He lay perfect- 
ly at ease : was now rational, but had showed signs of 
slight delirium at various times before. His pulse fal- 
tered gradually, whilst occasionally sleeping, and answer- 
ing correctly when questioned. The most perfect com- 
posure rested on his countenance after the pulse ceased 
to beat at the wrist ; occasionally in an easy sleep, and 
waking with calmness. The pulsations were so effec- 
tually ceased, that they could not be felt at the armpit ; 
and respiration hardly discernable ; yet he would wake 
easy and swallow small liquids; in other respects, he re- 
sembled a corpse. 

My determination was to trust his reviviscence to the 
more moderate stimuli, and the returning energy of the 
heart ; avoiding opium and the more extravagant quan- 
tities of stimuli. With this view he took brandy with 



SECT. V. SPOTTED FEVER. 261 

loaf-sugar, oil of cinnamon, &c. He continued in this 
state about an hour and a half; when the pulses returned 
to the wrist ; — they were feeble and slower than More. 
He was now treated with wine, brandy, bark, allspice, 
&c. but not in very great quantites, yet enough to have a 
very evident effect along with the expanding energy of 
the system, to restore him back to a state of high arte- 
rial action at the end of thirty-six hours from the fal- 
tering, when they were all discontinued. At the end of 
twenty-four hours more, being the beginning of the 
fourth day of his sickness, he was exercised with univer- 
sal soreness in his joints and muscles, so that he would 
scream when touched, attended with a redness of the 
skin, and as high a state of febrile action as I ever wit- 
nessed. His pulse was full, hard, and quick; he was 
bled now about ten ounces, and the next day about as 
much more, and treated in all respects upon the anti- 
phlogistic plan. These measures gave manifest relief; 
the blood was covered with inflammatory buff. 

The disease had now assumed a fixed character ; the 
latent energies of the system were drawn forth into ac- 
tion of a permanent kind, and he had no further signs of 
sinking. The fever gradually but slowly subsided, but 
not until after a considerable length of time, when it 
ended in perfect health. 

My determination was not to give this patient any 
opium ; and hitherto he had not taken any, nor until 
about three weeks of his disease. Whilst he was linger- 
ing under a moderate fever, the father of the boy had a 
wish for him to take some. I put him off for a short 
time, but others insisting also for its use, I consented, 



262 SPOTTED FEVEK. CHAP. VI. 

after telling him my opinion, and the probahlc conse- 
quences. I insisted that he should take the phial of lau- 
danum into his own hands and be particular, which he 
did. He took about twenty drops every twenty-four 
hours, in divided portions, which gave no stupifying ef- 
fect ; but at the end of three days made a sensible change 
in his disease for the worse. His pulse was very consi- 
derably increased, his tongue dry, was restless, and a 
very constant tremor, or subsultus tendinum, not only in 
his limbs, but in the muscles of his body. The father 
readily gave up the phial of laudanum ; and it was four 
days from this before he got back to what he was when 
he began its use. This circumstance is rather irrelevant 
to the subject for which this case was introduced, but it 
was thought best to connect the whole of the case toge- 
ther, which might save a repetition in another place ; 
more particularly to demonstrate the effect of opium in 
typhus fever. The boy had none of these tremors be- 
fore nor after what is mentioned. 

In this long case I am not suspicious of having mis- 
judged but in one circumstance, and that is altogether 
problematical. At the end of the first twenty-four hours, 
it might be supposed if he had timely been supplied with 
cordials, he might not have fallen into the sinking state. 
"Whether great stimulation would have saved him from 
this in part, or whether it would have forced the powers 
of the system beyond what it was capable of bearing, 
and ended in indirect debility, are very interesting 
questions ; and they are also difficult to be determined. 
For myself, I am satisfied to have this as it was. But 
it may be observed that oftentimes those great depres- 
sions, which supervene after the first attack, seem in 



SECT. V. SPOTTED FEVEK. 26o 

part, to be prevented by a pretty liberal use of agreeable 
stimuli. We will now resume the subject of blood-let- 
tmg. 

It will not be maintained that blood-letting is always 
necessary or even safe. It will only be insisted on, that 
it is often necessary, and sometimes indispensable. The 
opinion I had early formed with respect to this, and pub- 
lished in my third number on this disease in April 1811, 
is confirmed by subsequent experience. " As it has fal- 
len to my lot to speak in favour of blood-letting, and 
against opium, some might begin to think, that my whole 
intention might be to trust the cure to evacuations and 
debilitating remedies. But when reference is had to the 
indication laid down in the first number, this will be set 
right ; viz. to support and equalize action, when low, 
or depress and equalize action when high. Some cases 
I have met, where the most assiduous use has been made, 
from the beginning, of brandy, bark, wine, essences, and 
essential oils, cayenne, camphor, ether, &c. internally to 
support ; and to equalize action externally, warm bath- 
ing, blistering, frictions, with red pepper and rum, mode- 
rate and long continued sweating, &c. By equalizing, 
it may be understood to divert the morbid action from 
the internal parts and important organs, oppressed and 
agitated with pressure of blood and membranous inflam- 
mation, to the surface and extremities of the body. If 
excitement is kept up on the surface of the body, morbid 
action will spend itself partly there, and save the more 
noble internal parts from destruction. It is presumable 
that the pressure of the blood and peculiar inflammation 
of the membranes of the hrain diminish the nervous en- 
ergy, and maybe a cause of weakening the heart and the 



26* SPOTTED FEVER. 8HAP. VI. 

rest of the system ; so taking some blood oftentimes actu- 
ally gives strength to the action of the heart and system 
generally." In the first number, published March 18, it 
is there stated that bleeding has been practised more or 
less in about half the number of patients. And in the 
second number, published the 8th of April, the statement 
is, that "for the last fortnight I had bled about two-thirds 
of my patients ; and not in a single instance had any rea- 
son to regret it." 

One case, a little after this time, gave me some tem- 
porary uneasiness. A girl in the west part of Hartland, 
about nine years old, of a delicate constitution, had been 
sick three days. I was called to visit her in the absence 
of her physician. Her case was judged to be very seri- 
ous. It was my wish to let blood ; the family consented, 
as they said she could not live without relief. It being 
towards evening and not a good light, the orifice was 
made rather large, and in bleeding rather freely, more 
was taken than was intended. It was, perhaps, ten or 
twelve ounces, She directly fainted ; and continued in 
an alarming state for two hours, in which time the most 
powerful stimuli were used, and seemingly in vain, when 
I was obliged to leave her with only a forlorn hope of 
her recovery. I was, however, agreeably surprised, in 
going into that neighbourhood two days after, to see her 
almost well. Indeed nothing was needed to be done, as 
she had no disease upon her. She recovered in a short 
time after I left her from the state of depression, and im- 
mediately appeared free from disease. I do not justify 
so large bleedings under the circumstances of this pa- 
tient. This was the only case that gave me any reason to 
think, that I had taken too much blood ; and even this 
proved very fortunate. 



r. v. SPOTTED FEVER. '205 

The cast' of a young man, aged twenty, taken on the 
16th of Mareli, 1811. Severe at taek in the night. Bled 
the Irtt night, altheugh the pulse was very small and 
(jniek, and the patient evidently in danger of going sud- 
denly into a state of indirect debility. This patient was 
afflieted with an obstinate diarrhoea after the third day ; 
also severe strangury and tetanus. He was bled four 
times in all, and every time gave some relief. The opis- 
thotonos came on about the fourth day ; he continued the 
greater part of three days with his head and hips drawn 
back very greatly. A sparing use of opium internally, 
and a liberal use externally, was tried, but rather aggra- 
vated his case. Free bathing the whole body with olive 
oil and spirits of turpentine ; this, like every thing else, 
seemed to make no favourable impression upon the 
spasm ; he had been sweated freely, &e. A physician 
was called in for consultation ; I had previously proposed 
the fourth bleeding; he said that it made no difference 
what was done for him ; it could do no good. I was left 
to my own election, and bled him more freely than be- 
fore. The result of the case was a rapid recovery; and 
I find by my minutes, that on the ninth day he was con- 
valescent. 

Whilst visiting a family in Hartland, a man was 
brought into 4he house, who was seen to fall suddenly 
from his horse, upon the snow, in a cold day, aud sense- 
less ; he was brought about a quarter of a mile in this 
situation, and laid before the fire. His pulse was scarce- 
ly perceptible, with crimson flush in the middle of his 
cheeks; wholly insensible. He was immediately warmed, 
and got into a sweat with a few simple internal stimuli, 
with a little spirit. The next day when I went to see 

3i 



2G6 SPOTTED FEVER. LHAP. VI. 

him, he bad an eruption of the fine brown petechia with 
lever and pain. He was now bled, and the usual course 
pursued, a cathartic, sweating, &c. and in four days he 
was convalescent. 

Cases might be multiplied to show the utility of blood- 
letting ; and also to show that the stimulant plan indis- 
criminately adopted, was not to be relied on. Selections 
of this kind might be offensive, nor am I at liberty to 
give them ; they will therefore be dispensed with. An 
injudicious use of blood-letting, as to time and circum- 
stances, is as bad as not to bleed at all, perhaps worse* 
It might here be observed, that no person ought to at- 
tempt to treat this disease, unless he is pretty well ac- 
quainted with the physiology of the human system in 
health and in disease. The diseased action is so various in 
different cases, and mutable in its character, that dogmas 
and nostrums can but accidentally meet its eccentricities. 

Two states of the system will now be adverted to, 
showing the varieties of diseased action, and the propri- 
ety of using different remedies. The first is a state of 
lowness in the whole system from the beginning, attend- 
ed with faintness and sighing ; a weak, comparatively 
slow, compressible, trembling, and retiring pulse. Per- 
haps puking may attend, perhaps not. This may be the 
condition at the attack ; it may recur at after stages of 
the disease. In this case stimulants are indicated, and 
they are useful ; but not without measure, or in such a 
manner, as to force the action beyond what the excitabi- 
lity of the system can bear. Perhaps twenty or thirty 
drops of laudanum may be given, and the rest trusted to 
cayenne, wine, bark, cinnamon, allspice, essences, bran- 
dy, &c. Let these last be given every ten or fifteen 



SECT. V. SPOTTED FEVER. 267 

minutes, as the case may be; not more than is sufficient, 
after a reasonable time, say an hour or two, to excite 
energy and raise the pulse, along with external means. 
The particular quantities must be regulated by the par- 
ticular symptoms, under the direction of the physician 
who is observing the state of action the whole time. As 
soon as energy is in part restored, these measures should 
in part be laid aside ; perhaps wholly ; for quickness of 
pulse or high action is wont to succeed to very low ac- 
tion, and in this case as much injury may follow as could 
be apprehended from the reverse state ; unless counter- 
acted in season. These cases are not so frequent. When 
they do happen, perhaps they may better be trusted to 
other stimuli than to opium. I never had so good suc- 
cess as I had the first six weeks of the disease in 1811 ; 
when observing the bad effects of opium, in certain cases 
not in my control, I had determined to see if the disease 
could not be managed without it. The result was then 
given the public in my first number. " I will take all 
ages and sexes into my account, and state that of eighty- 
one decided eases, committed wholly to my care, and 
treated as above and without opium, one case only, (the 
first case of the boy mentioned above) proved fatal. In 
this the patient was not bled. The cases, in which 
I was called to visit the patients of other physicians, are 
not taken into the account ; nor the relapses of the same 
patients, which have been frequent, but not fatal." It 
will be noticed, that in the case of the boy alluded to, he 
took a small dose of laudanum, just as he was expir- 
ing, not expecting any good or harm from it ; and not 
thinking it worth mentioning. I believe not one of the 
«thcr patients took a dose of opium, during this time- U 



268 SPOTTED FEVER. CHAP. VI. 

was mentioned, however, in a subsequent number, that 
one of the above cases, a boy about ten, from doing 
apparently well, died after the statement was published. 
The other state of the system is, where the signs of 
great depression at the first onset are not very manifest. 
More acute pain attends than in the other ; an inclina- 
tion to sleep ; some spasms ; flush in the cheeks by turns ; 
some accumulation of heat. The pulse is soon after the 
attack rather full and a little elastic ; but soon grows 
smaller and quick almost beyond example. If tbe dis- 
ease is not arrested, the pulse becomes tremulous, and 
evanescent, and in a few hours excitability is extinguish- 
ed. I have never known high stimulants avail any thing 
in these cases to restore the sinking state of the pulse. 
It may here be observed, that when the disease first 
appeared in this place, it was principally confined to the 
village | and I seldom had more patients at any one time, 
than I could attend as was necessary, with much labour. 
After the first two months the greatest number of pa- 
tients were at a much greater distance, and the travel- 
ling very bad. These circumstances lessened the num- 
ber of visits, and brought me in contact with a number 
of late cases, both at a distance and near home, in which 
the most precious time, to afford relief, had already pass- 
ed; in these cases the pulse was inconceivably quick, 
and the powers of the heart and arteries retiring before 
the load of oppression. As a dernier resort, opium, 
brandy, &c. were effectually tried in some cases, but 
without any benefit, that I could discover. After cases 
like these have progressed to a certain degree, even 
some time before the pulse has retired, I do not pretend 
to know of any remedy that is very likely to save the 



SECT. \. SPOTTED FEVEK. 269 

patient ; but in all these cases, if the fortunate moment 
U well improved, whilst the pulse has some fulness, and 
be i ore it has increased to the greatest frequency, by 
bleeding, warm bathing, stimulating frictions, blistering, 
fee. there may be a great prospect of saving the oppres- 
sion of the vital organs and restoring the patient in due 
time. These cases have occurred so frequently in a 
very formidable manner, and have been so uniformly 
relieved by the principal remedies just named, and others 
of minor importance, that I feel disposed to speak with 
much confidence in their use in preference to the indis- 
criminate use of high stimulants. When we consider, that 
these cases terminate in six, twelve, or twenty-four hours 
in death, and not unfrequently before medical aid can be 
procured, the importance of early and strict attention 
will be manifest. Not only this, the honest physician 
needs often to offer the sacrifice of a broken heart for 
want of judgment to apply correct principles in the most 
eritical and perplexing moments. Amongst several that 
fell to my lot under peculiar embarrassments, being ex- 
ercised with the above described state of the disease, and 
in a too advanced period for relief, will only be mention- 
ed the endearing young Miss 

" Crop'd like a rose before 'tis fully blown, 
Or half its worth disclosed." 

After a fatiguing walk she was attacked at nine in the 
evening. A neighbouring friendly woman attempted to 
sweat her in the usual manner, and applied too much 
heat and spirit. I first saw her at the end of seven 
hours. Pulse 160, great heat, and no sweat had been 
procured ; partly delirious, partly comotose. Signs of 



270 SPOTTED FEVEK. CHAP. VI. 

extensive internal inflammation ; died at the end of 
twenty-six hours ; bled but once. 

The more candid and intelligent part of the Faculty 
in this section of the country, adopted the practice of 
blood-letting at different periods of the epidemic ; so that 
it was pretty generally practised ,• in a very partial man- 
ner, however, by some. If a patient was bled once, that 
required it perhaps three times, and the case went wrong; 
the fatality was often imputed to his having been bled. 

A reputable physician at a distance, with whom I con- 
versed on this subject, at the beginning of the epidemic, 
and who was wholly devoted to the stimulant plan, in- 
formed me in the month of May following, that he had 
practised bleeding much to his satisfaction, and that he 
bled in this disease, in his opinion, more largely than I 
did. 

Some analogy really seems to exist between this dis- 
ease and some conditions of intermitting fever. Bleed* 
ing has generally been condemned in this. But a late 
celebrated writer, Senac, says, " It may be laid down 
therefore as an established principle, that if venesection 
does not absolutely cure intermittents, it paves the way 
for other remedies, and is on that account highly neces- 
sary." 

It should be particularly kept in mind, that when 
bleeding is practised in the low oppressed state of fever, 
attended with a weak, quick, and unstable pulse, the 
patient should be agreeably warm, and in a recumbent 
position ; and these circumstances being attended to, we 
have not met with the bad consequences apprehended by 
some. When practised in this manner, the operation 
seems to have a better effect in diffusing action upon the 
surface, and removing coldness and constriction. 



SECT. V. SPOTTED FEVER. 271 

Arteriotomy in the temples, and opening the external 
jugular veins have been practised ; but we are not 
confident, that they possess any advantage superior to 
taking blood from the arm or hand. 

If it should be suggested by some, that this being a 
disease of spasm and of the nervous order, that therefore 
stimulants are particularly indicated ; it would be ob- 
served in answer to this, that stimulants are not advisa- 
ble in those cases of spasm, connected with fever and 
inflammation. Instances of this sort are familiar in 
hysteria, and in the common convulsions of children. 
Nothing is more common than for some to employ opium 
in these two conditions of disease emphatically called 
nervous, and nothing is more common than for them to 
be disappointed in the good expected from it. It is 
believed that nine tenths of the convulsions of children 
arc connected with pain and fever, which is so much of 
the sthenic character, as to prohibit the use of opium in 
correct practice. The warm bath, venesection, and a 
cathartic will commonly change the intolerable distor- 
tion of the little sufferer into enlivening smiles; whilst 
opium as commonly increases the direful disease, or 
changes it into a fatal hemiplegia. In hysteria, opium is 
very objectionable, though not so fatal. In many other 
cases of clonic spasm, opium is not only useless, but 
hurtful. 

It is time to pass to other curative means for this dis- 
ease. Emetics have been used sometimes successfully, 
and sometimes the reverse. The indiscriminate use of 
emetics is generally disapproved, and very justly. From 
the great irritability of the stomach, emetics are apt to 
go to excess? and where the stricture of the surface 



272 SPOTTED FEVER. CHAP. VI. 

and extremeties of the body cannot be overcome by the 
exercise of puking, the strength of the system is weak- 
ened, spasm of the stomach induced, and the patient 
left worse. But on the contrary, if the torpor on the 
surface is not considerable, and the vital energy not 
greatly lessened, the exercise of emetics may overcome 
it, assisted by external warmth, and benefit the patient. 
But after all, their good effects are doubtful, and they 
hardly ought to be trusted at the onset of the disease. 
Their use may be dispensed with on account of evacu- 
ating bilious matter, as this is seldom to be found in the 
beginning of the disease. 

In mild cases, they are useful at the attack ; and in 
other cases more severe they may be employed as in other 
fevers, after the disease has progressed into a regular 
and fixed character. 

Very nearly the same observations may be made upon 
the use of cathartics, that have been made upou emetics. 
It is best to wait in severe cases of lowness with slow 
pulse, and note the energy of the system before cathar- 
tics are used. The pain they occasion, is often very 
debilitating ; but the evacuation they produce, and the 
translation of excitement from the head they effect, is 
often very useful in relieving the congestions in that part. 
They ought, therefore, to be used, as soon as the cir- 
cumstances of the case will admit ; and enemas used in 
the mean time. The common aloetic pills answer pretty 
early to be given ; it is our practice to combine calomel 
with these most commonly ; and often times to manage 
them so that they shall have a full operation by the 
second or third day. In the greatest number of cases., 
they ought to be used the first day. 



SECT. V. SPOTTED FEVEK. 273 

Blistering ought to follow as soon as the patient has 
had warmth applied in the first instance. It is of 
great efficacy in promoting excitement on the surface ; 
the absorption of a safe stimulus from the flies is sup- 
posed useful, as also the mechanical irritation upon the 
skin helps to increase sensibility in lethargic cases. They 
may be applied to any part of the body ; but in the attack 
of the disease they are judged to be of most efficacy on 
the limbs and trunk of the body, in making a revulsion 
from the head. Afterwards, if the case partakes more 
of inflammation, with warmth in the extremities, they 
may be applied to the neck or head. If strangury comes 
on, they should be discontinued, and demulcent drinks 
given internally, and embrocations of anodyne balsam to 
the hypogastric region frequently repeated ; also cloths 
dipped in warm milk and water; also semicupium. 

Whilst the indiscriminate use of large doses of opium 
and other stimulants is discountenanced, it will be ac- 
knowledged, that in certain conditions a judicious use of 
them may be useful. In the cholera morbus state of the 
disease opium becomes very necessary ; and it should be 
given in conjunction with brandy, and other agreeable 
stimuli, until puking is mitigated. At the same time 
using external warmth and venesection, if the pulse will 
admit of it. 

In this last state cayenne pepper, or even the common 
red pepper of the garden, has been used.to advantage in- 
ternally and externally; these are good in all states of 
Iowppss. These have appeared safer than much opium 
or alcohol in exciting warmth in the system. If relief 
is not soon obtained by these measures, it will often be 
proper to avoid giving any thing to the patient? eve© 

35 



274 ST0TTEB FEVER. «IIAP. VI. 

mild liquids, until vomiting subsides. Our views of the 
use of eold water internally and as applied to the head, 
may be learnt in Chap. v. Sect. 2. 

In the colic state of the disease, moderate doses of 
opium are useful, with the usual external remedies, and 
they are here safer, than in attaeks more confined to the 
head. Cathartics should not be early given ; but after 
blistering and warm fomentation to the abdomen, mild 
enemas should be first used. This state of disease is not 
very frequent, but is sometimes very distressing. It 
often requires the use of bleeding after the first day. 

Frictions are useful to the surface ;Jthey are more effi- 
cacious when used with red pepper and spirit made hot. 
A coarse woollen glove may be used for this purpose. 

For the purpose of exciting the cutaneous capillaries, 
the seneca root is very beneficial. It may be given in 
powder or infusion. As much should be taken as the 
patient's stomach will bear without producing sickuess. 
If puking is required, this may be used for that pur- 
pose, mixed with ipecacuanha. 

For a tonic, Fowler's solution of arsenic has best an- 
swered our purpose. It may be given from three to six 
drops every four hours ; or as the case may be ; perhaps 
more freely in some cases; but not so as to disturb the 
bowels. We have seldom depended on this in the first 
attack ; it seems to be more useful after depraved action 
is corrected in part, in order to give stability and regula- 
rity. Perhaps disagreeable consequences might arise 
from a long continued use of this remedy; it cannot be 
needed but a few days in this disease. Notwithstanding 
what has been suggested above, in very low cases attend- 
ed with slow tremulous pulses, it may be given upon the 



S«CT. VI. SPOTTED FEVEK. 275 

first attack, and along with other tonics and stimulants ; 
and if the strength of the system emerges, may be fol- 
lowed by bleeding. 

V> the appetite in this disease is less impaired than in 
almost any acute disease, it is an indication that nature 
requires the use of food, and this is conformable to expe- 
rience, as it seems to be beneficial. The patient maj 
use such articles as are most agreeable in small quanti- 
ties, and often repeated. Animal broths appear most 
proper. For the treatment of this disease after it has 
assumed a fixed character of the continued kind, see 
Chap, x. 

SECTION VI. 

Sequel of Spotted Fever. 

A peculiar state of chronic illness, as the sequel of 
spotted fever, was hinted at in Chap. v. Sect. 3. The 
subject not having been treated of by any writer to my 
knowledge, it may require some further consideration 
in this place. As this chapter is extended already fur- 
ther than was contemplated, brevity will be studied. 

The subjects of this disease have been young men, or 
young women, with a few exceptions ; most commonly 
the latter. They have most frequently been such as had 
the epidemic rather lightly, or not in the severest man- 
ner. Several that I have seen, in the relation of their 
illness mentioned, that in the epidemic season, perhaps 
several months past, they were somewhat unwell for a 
few days ; did not send for a physician, got better, re- 
mained unwell, and gradually grew worse; but did not 
think they had the disease. Others remained more in a 



376 -potted tKYJBB. ciiAr. vi. 

stationary state from the attack, and very gradually grew 
worse. From a strict analogy in the appearances, it has 
been uniformly my opinion, that these slighter affections 
were a miniature of the same epidemic. 

The condition of those who are affected with this 
chronic illness, after more serious attacks, was, that they 
were never free from the disease, yet relieved in part. 
Some continued so unwell as to be confined, others 
were able to attend partially to business ; but a very lit- 
tle exercise, and a small deviation from accustomed ha- 
bits, was sure to make them worse. Persons so affected 
are averse to exercise ; feel great lassitude upon muscu- 
lar motion, and incline to keep in the bed. Indeed some 
were so reduced, that it was difficult for them to sit in 
a chair for months together: whilst others would be 
able to attend to business half the time, aud the other 
half of the time be confined. If they got some better by 
common treatment, it was only a deceitful respite, and 
the patient had shortly to submit again to confinement. 
In this manner months and years have been passed by 
some, whilst others have had a more speedy recovery. 

The pulse has commonly been from SO to 120 in a mi- 
nute, small, and rather hard. The appetite for the most 
part good, digestion well performed ; and the alvine 
excretions regular. Nothing remarkable in the other 
excretions. All were affected with pain somewhere. The 
pain was often in the head, frequently in the side, often 
in the stomach. "When in this part, food gave much dis- 
tress, although taken with a good relish. The pain was 
often shifting, aud occasionally it was in the limbs. 
Hands and feet inclining constantly to be cold and damp. 
The countenance retained very much its natural appear- 



. \ i. -potted ye>EK. 875 

ancc : and oftentimes it would he difficult, from a ll 

m, to discover from the physiognomy, that the 
I vitt much out of health; if we except ■ flight 
ing and transparency which are sometimes present. 
The tongue is very constantly covered with a thin white 
coat, and moist. Much solicitude and anxiety of mind 
attended, and they would often utter desponding moans. 
In >hort, nothing but a chronic fever can be discovered, 
with strong marks of parental likeness. 

It is peculiar to this affection to maintain its charac- 
ter, and perpetuate its continuance. I have never known 
it induce any other disease in the system, even when it 
bad continued for years : unless it was in one of the most 
obstinate cases that I ever saw, attended with pain in the 
head, hemicrania, with tetanus, 6cc. endiug in a state of 
deafness and idiotism, connected as is supposed with hy- 
drocephalus. This ease is of more than three years' 
continuance : it had its origin from a very mild attack 
of the fever ; the patient attended to business several 
months after, and was but little indisposed. After an 
evening's exposure, he grew worse. Although the suf- 
ferings of this patient have been beyond description, he 
commonly retained his appetite and plumpness of body.* 
I have never known it prove fatal either in its own 
character, or by inducing any other disease. At the same 
time, it is one of the most obstinate of all the curable 
diseases, and not very often removed by the salutary ope- 
rations or adaptations of the system. Notwithstanding a 
very great proportion got well after some monthi under 
a severe regimen; whilst many others, under a tempo- 

* After writing the above, in December. 1814. I saw this 
patient, and his health was somewhat better. 



278 SPOTTED FEVER. (JHAP. VI. 

rising treatment, arc sick for years. I was lately applied 
to by a man who had the spotted fever in 1811, three 
years past ; who has been indisposed ever since, and tried 
all methods but the right one ; sometimes able to attend 
a little to business, at other times confined, at all times 
attended with pain in some part of the thorax, hypochon- 
dria, or head, with cold extremities. He had a tole- 
rably good appetite, and was inclined to obesity; he 
entertained for himself suspicion of dropsy; a small, 
quick, and oppressed pulse. In the course of two months 
he was bled four full bleedings ; took repeated doses of 
emetics about every third day, and in the intervals, re- 
peated doses of drastic physic; using the warm bath, 
every evening or every other evening, followed by sweat- 
ing. In the above mentioned time he appears free from 
disease, and with as much strength as he had before be- 
ginning the above operations. It may be observed, that 
for the last fortnight of the two months, he practised but 
little of the above operations ; but he was not materially 
weakened at any time. He appeared to be rapidly gain- 
ing his strength. Three months after writing the above, 
he remains well and able to labour. 

"What the particular state of the system is, which 
keeps up this indisposition, will be difficult forme to say, 
unless it be that the primary derangement is not yet re- 
moved. It is conceived to be in the finer orders of 
vessels, and most secret recesses of the system. But 
what order of absorbent vessels should be so long and so 
permanently affected, without inducing more derangement 
in the rest of the system, may be difficult to be explained ; 
perhaps the torpor only partially affects some particular 
order. It is highly probable, that the internal membra- 
nous inflammation is always present more or less. 



SECT. M. BFOTTBB SEVER. 279 

1 have seen a variety of methods of cure experiment- 
ed ; but only one method has appeared to me to give any 
permanent benefit. This is the same, as near as personal 
circumstances will permit, with that mentioned above 
for (he eure of the original disease of spotted fever. It 
seems that in all fevers just so much must be done, 
cither by nature or by the assistance of art, before the 
subject is restored to health ; and this seems to be what- 
ever is sufficient to remove the primary derangement, or 
more commonly speaking, the primary cause. This 
last may be so circumstanced, along with the personal 
peculiarities of the subject, that if they are not suddenly 
removed, the system must be destroyed. Again, they 
may be less extensive or in part mitigated, and in a sub- 
ject possessing personalities opposed to sudden destruc- 
tion, may continue an indefinite length of time. It can 
hardly be supposed, but that these cases must end in in- 
curable disease after a length of time ; and perhaps in 
some instances have already. 

Although there is a great degree of debility in the 
organs of loco-motion, a small pulse, aud a deficient 
circulation in the extreme vessels, the subjects of this 
disease bear bleeding, puking, purging, and moderate 
sweating to a great degree, without growing weaker or 
showing many signs of increased debility. Xot only 
this, but it is a fact capable of demonstration, that where 
these remedies are used freely, the patient grows stron- 
ger as soon as the faligue and immediate depression is 
over, which is only a short time. The circulation be- 
comes more perfect, as is proved by the warmth in the 
hands, feet, &e. The pain is mitigated, and by persc^ 
verance in the use of these means, health is gradually 
restored. In some cases of long standing, the system 



280 SPOTTED FEVER. CHAP. VI. 

must be as it were revolutionized by the operation and 
agitation of severe measures. Tiucture of digitalis 
seemed sometimes useful. 

It may be difficult to say what proportion of cases ter- 
minated in this chronic illness ; the most correct opinion 
I eau form on the subject is, that about one in ten or 
twelve of all that were affected, ended in this state of 
disease ; this is supposed to include the slighter cases of 
attack. They most frequently get relief in the course of 
a few months by proper treatment. I do not recollect a 
single instance of this chronic illness succeeding those 
cases, where the evacuant and excitant method of cure 
was properly persisted in. 



CHAPTER VII. 



EPIDEMIC PERIPNEUMONY. 



" Why licensed pain, 

That cruel spoiler, that embosom'd foe, 
Imbitter'd all our bliss V* 



SECTION I. 

Preliminary Observations. 

This disease has been called by some pneumonia 
typlwides. It might as well be called by this as any 
other name, were it not for the idea of its having an affi- 
nity to typhus fever, not only in its name, but in its 
treatment. This has actually been the case ; and al- 
though the more noble and vital organs are assailed 
with inflammation of the most destructive kind, yet 
many have been deterred from using the most suitable 
means of relief, from an apprehension, that it would 
not do to practise those remedies forbidden by some 
to be used in that disease, to which this word implies it 
to be allied. 

Winter pneumonia, or epidemic pleurisy, is a pretty 
common disease. It may be found recorded in many of 
the histories of epidemic diseases. It frequently follows 
the pestilential diseases of the summer season, in all 
countries north of the tropical line. It often follows the 

36 



Ufel I'ERTPNEUMONY. CHAP. VII. 

plague. lu countries visited by epidemical diseases for 
several years in succession, this pulmonic affection will, 
occasionally, break out in places or districts, not immedi- 
ately infested with the most general epidemic. In this 
case, as it respects geographical situation, it may precede 
the reigning epidemic., in certain places. Instances of this 
were met with in the winter of 1S09 — 10 ? when spot- 
ted fever prevailed in many places in the New England 
states, this pneumonic affection prevailed in some places. 
The spotted fever prevailed most generally in the win- 
ter of 1810 — 11, but it was not until the winter of 
1S1-2 — 13, that the pneumonic fever became general and 
distressing. Something like this happened in the win- 
ter of 1794k — 5: when pneumonia prevailed in connec- 
tion with canker-rash. Although in this immediate 
vicinity, this last disease was most severe in the winter 
of 1795 — 6, yet it had been in the country two years be- 
fore. These circumstances tend to show the affinity of 
epidemic diseases, and their mutability of character 
from a change of the local affection : and also prove the 
folly of a supposed specific contagion. The influenza 
commonly precedes severe pestilential diseases, and 
pneumonia generally follows them. 

There was a great similarity between the pneumonia 
of the winter nfl79i — 5, and the present disease ; with 
this difference, that it had rather a more steady charac- 
ter, and inclined a little more to the sthenic diathesis at 
the onset of the disease: which proves the hurtful im- 
pressions to be less severe. The controversy was great 
at that time respecting the treatment, and many appear- 
ed to perish for want of a bold and energetic use of the 
same remedies, that promise the most benefit in the 
present instance. 



SBCT. I. PERIPNEUMONY. 283 

All epidemic diseases, that invade the system rapidly, 
or that have a sudden access, from strong predisponent 
liability to affections of the more noble organs, show 
great disparity of action, especially in the final attack. 
The symptoms of fever, or of high excitement, are not 
in proportion to the degree of danger ; but are more 
nervous aud mutable. The symptoms of strong arte- 
rial action, called sthenic, are not very manifest at the 
onset. This is supposed to arise from a severe im- 
pression of disease and a peculiar affection of the or- 
gans, supplied from the sympathetic nerves. A state of 
depression seems to be present, and a strong tendency 
to fall into sudden exhaustion and death, before the la- 
tent energies of the system are drawn forth into action. 
This state of the system has been called malignant as 
before observed. And as the phenomena aud treatment 
have been discanted on previously, they will now be 
passed in silence. It will only be observed, that if the 
locality falls on the muscles of the thorax and on the 
pleura, or on the ligaments of joints, we have a case of 
common sthenic, or inflammatory fever from the begin- 
ning. 

The disease of 1811 and 1S12, called petechial fever, 
and the present epidemic, seem to have many things in 
common. This is inferred from the suddenness of the 
attack in both: from their rapid progress; from the 
sudden prostration of the vital principle : from nearly 
the same appearances of internal membranous inflam- 
mation on dissection ; from their mutability of charac- 
ter as shown by external appearances ; from a close con- 
nexion in the epidemic period ; and from a deceptive 
exhibition in showing a greater degree of debility, than 



28* PERIPNETJMONY. CHAP. Til. 

actually exists in the system, when its energies are 
emancipated from the temporary oppressing powers. 

They show also an affinity in this, that in 1810, '11, 
and '12, some cases of pneumonia appeared, and in some 
few places, this predominated. In 1813, some cases of 
petechial fever appeared. One further analogy will be 
hazarded, and without a desire to gainsay; that on 
general principles they required the same treatment. 
This difference, however, will be noted, that the present 
disease offers a greater number of cases than the other, 
where the depleting plan of cure should be carried to its 
fullest extent. 

The chief difference seems to consist in the locality of 
the principal affection. In the disease of 1810, '11, and 
*12, it was in the head; in 1813, it was in the thorax. 
And these circumstances go far in explaining the phe- 
nomena of the two diseases. Neither of the diseases 
was strictly confined to one of these parts or the other. 
When most in the head, the diseased affection could be 
slightly traced in the thorax ; and when in the thorax, 
some could be traced in the membranes of the head. 

All that has been advanced in the previous chapters, 
relative to the oppressed state of (he system at the 
attack of severe epidemic fevers with internal inflam- 
mation, whereby a deceptive debility is liable to impose 
upon the judgment of the observer, may apply in the 
present epidemic. The most alarming attacks, are often 
not attended with a chilly fit, but with coma ; a depres- 
sed, low, intermitting pulse ; at length small and quick. 
Coldness of the surface, &c. which denote that state of 
disease called malignant, and marks the highest grade 
f»f danger, and requires the most prompt and energetie 



SECT. II. rERIPNEUMONY. 28p 

measures, to change this state of disease into one less 
dangerous and more manageable. 

SECTION II. 

Dissections, §c. 

I had no opportunity of making dissections myself. 
Dr. Perkins of Bridgwater and myself agreed to im- 
prove the first opportunities: in a very short time, we 
were both attacked with the disease. It proved^afoi to 
him. Some circumstances, relating to my own case, will 
appear in the sequel. From previous dissection in for- 
mer cases of pneumonia, 1 felt satisfied of the condition 
of the local affection, and made a report of my opinion, 
the beginning of June, as will presently appear. It was 
with much satisfaction, that I found ample testimony of 
what I had advanced, in the dissections of Dr. John C. 
Warren, published in July following, in that valuable 
work the New England Journal of Medicine and Sur- 
gery. 

Dr. Huntington has lately communicated the follow- 
ing summary of appearances in two cases of dissection. 
In a middle aged man, the heart was in a high state of 
inflammation; the pericardium and lungs in a gangre- 
nous state. Liver inflamed. The other a woman. Near- 
ly the same appearances, only the lungs exhibited signs 
of high inflammation instead of gangrene. No mention 
was made of symptoms, or the duration of the disease: 
but the pulmonic epidemic of the winter 1812 — 13. 

The following anomalous and strongly marked case, 
was obligingly sent me by Dr. Tracy, of Hartford. 



286 PERIPNEUMONIA UHAP. YII. 

About the middle of the epidemic season, T. D. a 
middle aged, athletic man, was attacked with symptoms 
of fever, attended with pain and swelling in the throat, 
particularly of the thyroid gland, and with symptoms of 
croup ; and also with difficult and obstructed deglutition. 
On the second day, severe symptoms of pneumonic in- 
flammation more distinctly appeared ; the pulse which 
was quick, weak, and irregular at first, was now strong. 
The pain and inflammation were severe ; and the patient 
expired on the fifth day with apparent suffocation. The 
above symptoms were related to our correspondent at 
the time of dissection. 

On examination, ten hours after death, the swelling of 
the throat and thyroid gland externally, and collection of 
dense coagulable lymph in the trachea, so effectually 
obstructed the passage, that the lungs could not collapse 
until punctured. The pleura, mediastinum, diaphragm, 
lungs, pericardium and heart, showed strong marks of 
inflammation. Adhesions were formed in different parts. 

There was an appearance somewhat like vesicles, 
over all the inflamed parts, filled with purulent matter. 
In addition to this, there were about two pounds of pu- 
rulent, mixed matter, in the cavity of the thorax. The 
exudation in the trachea extended from the larynx about 
six inches, and of the consistence of cheese-curd. This 
patient had one small bleeding. 

The subject of blood-letting in this disease is very 
important. It seems to be, as it were, the dividing line 
between the two kinds of practice pursued by different 
physicians. As its utility appeared to my understanding 
very conspicuous, I felt a freedom to advocate its use. 
I wish here to express my satisfaction at seeing, in the 



9EGT. II. PERIPNEUMONY. 287 

publication above alluded to, reports of cases demon- 
*traiing the efficacy of this remedy in the present dis- 
l)v Doctors Gamage and Jackson. See Med. Jour. 
Vol. n. for July. The testimony of Dr. Gamage is so 
consonant to my own opinion, that the liberty is taken to 
insert a few lines of his report. "By the politeness of 
friends, I have been present at three or four examinations 
of those who died by this disease. The phenomena exhi- 
bited on those occasions, the hardness of some parts of 
the lungs, their gorged state, their dark colour, approach- 
ing almost to black, the pericardium thickened, or cover- 
ed with livid spots and other marks of the most violent 
inflammation, demonstrated to me, in a manner the most 
positive, the necessity of copious evacuations of blood to 
cure the disease notwithstanding the forbidding aspect 
of the pulse, which commonly attends it. I was indebted 
to an early opportunity of this kind for, at least my 
confidence in bleeding as a principal remedy ; and so far 
as I have known, every case, in which this remedy had 
not been used freely and early in the attack, has termi- 
nated unfortunately." 

Several statements also in the Medical Repository 
from respectable authority tend to establish the utility 
of blood-letting. For the purpose of saving labour, and 
giving my early views of the present disease, I have 
concluded to finish this subject by inserting the follow- 
ing sketch already in manuscript. 



288 PEUIPNEUMONY. 6HAP. VIJ. 



SECTION III. 

Dissertation on the cause, phenomena, and treatment of 
the fever which prevailed as an epidemic in Ver- 
mont, in the winter of 1812 — 13. Bead before the 
Windsor County Medical Society, on the eighth of 
June following. 

PERIPNEUMONIA EPIDEMICA. 
GENTLEMEN, 

Devoted as I am, with the fellows of this society, to 
the promotion of medical science, and the happiness of 
mankind ; I wish not to he negligent in attempts to im- 
prove the knowledge of our art, or in recording facts 
and occurrences which are before us, in compliance with 
the bye-laws of this society. 

As all objects around us are mutable in their cha- 
racter, so diseases are liable to change. This view 
of the material world has excited the compassion of the 
benevolent in all ages. If we cannot comprehend the 
whole design of this mutation, it still has its use, in de- 
monstrating the wisdom and perfections of the Creator; 
and as it respects disease, it is of use, in exciting us to 
vigilance and exertion, whereby we become better ac- 
quainted with the properties of matter, and the science 
of life, health, and disease. But a short time since, we 
were assailed with what was considered a new disease ; 
at the present, if our epidemic is considered less novel, it 
must be considered as equally formidable with the other ; 
and the peculiar diagnosis of both warrant the assertion, 
that they are nearly allied, and belong to one family. 

The disease, which is the subject of our present re- 
flections, made its appearance about the 20th of Decern- 



SECT. 111. FERIPNEUMONY. 289 

ber last, in our vicinity ; but ;\t the northward and west- 
ward among the soldiers, who were more exposed to the 
exciting causes, from the best information I can obtain, 
it began its ravages nearly a month earlier. 

There was no discernible difference in the weather at 
that time, nor previous, from what is very common, or 
from that which is usual in seasons attended with much 
health. The autumnal months may be said to have been 
rather wet and cold compared with other years, but the 
difference could not be great. The sensible qualities of 
the atmosphere, especially after the first of January, 
were not very different from what was experienced two 
years before, when this same latitude was visited by the 
epidemic, called spotted fever, of which the present seems 
to be a sequel, and very similar in many of its symp- 
toms. The winters of both these years were rather re- 
markable for a series of steady cold, without the thaws 
usual in this country, and without much rain ; with an 
uncommonly serene sky. It may be, however, remark- 
ed, that, for several previous summers, there was an 
unusual fall of rain, and rather cold weather, so that the 
harvests of corn were very scanty, and generally of poor 
quality in this latitude. 

Whatever may have been the predisponent cause of 
the disease under consideration, I think it must have 
been of a very general and extensive nature, and connect- 
ed with, and depending upon, some particular state of 
the atmosphere ; and we must expect to look in vain for 
its origin from any local cause alone, as respects geo- 
graphical situation ; or as depending on any particular 
kind of aliment taken into the body. So far as my ob- 
servation extends, there was no difference in the number 

37 



290 PEKIPNEUMONY. CHAP. Til, 

of attacks and severity of the disease, in those who used 
corn of less perfect quality, and those who used this ar- 
ticle of bread in its more perfect state. At the same 
time, it is worthy of observation, that those who were 
less exposed to the exciting causes, and avoided the cold 
of winter, fatigue, and the depressing passions of the 
mind, &c. more generally escaped the disease. 

The extensiveness of the disease has been so great in 
the northern states, that the appellation of epidemic is 
almost lost in that of pandemic. So far as my informa- 
tion extends, there are but few towns, whose surviving 
inhabitants will not long, with grief, remember the win- 
ter of 1812 — 13, for the loss of twenty, forty, or eighty, 
of its most valuable citizens! Most valuable to society, 
on account of their being adult persons, and generally at 
the acme of human life. Few children have been the 
objects of its rage. One circumstance deserves atten- 
tion ; that where one of the heads of a family perished, 
the other soon followed ; what I mean is, that this fre- 
quently happened, and has been judged by many to have 
been more common than has happened within the memo- 
ry of man. 

It will be assumed as a fact, that this disease is not 
contagious or communicable from one person to ano- 
ther ; and that the predisponent causes exist in tiie at- 
mosphere. What these are I shall not at this time offer 
an opinion, nor how they may be produced ; but confine 
my observations, 

1st. To the effects of it on the system 5 and as it is 
connected with its exciting causes. 

2d. To a few of the peculiar phenomena of the dis- 
ease : and 



SECT. III. PERIPNEUMONY. 291 

3d, To remedies suited to relieve the system from dan 
ger of destruction. 

The undue proportion of the constituent principles 
of the atmosphere, is sure to affect the systems of men 
in proportion to the degree of this change in its healthy 
state ; and in a particular manner according to the na- 
ture of the change so made. This is sufficiently proved 
by numerous facts of what are called suffocating mephi- 
tic gases, exhaling from the earth, and destroying life 
instantly, or exhaling from places affected with a delete- 
rious principle, which does not sensibly affect the system 
at the present time, but shows its effects after an uncer- 
tain time, being brought into action by an existing cause; 
as we see in the miasmata producing typhus and inter- 
mitting fever. Thus a more general change may take 
place in the atmosphere, which may affect the bodies of 
men in a manner not so readily to be apprehended ; but 
the effects warrant a change being made, as clearly as 
we can apprehend the different temperaments of men, 
and their various susceptibilities of disease ; or as satis- 
factorily as the presence of intermitting fever proves the 
exposure of the subject to the misasmatic influence. 

There is something more than mere conjecture in the 
supposition, that certain predisponent principles in the 
atmosphere have a particular effect upon certain func- 
tions of the system ; for instance, the primse vise may 
become impressed in an especial manner by one kind of 
predisponent influence, as takes place in dysentery. The 
throat may be affected in like manner, giving origin to 
what is called canker-rash ; or the predisponent principle 
may have a peculiar effect upon the membranes in the 
)eead, &c. as in spotted fever; or upon the membranes of 



292 PERIPNEUMONT. CHAP. VII. 

the thoracic viscera, as takes place perhaps in the 
present kind of pneumonia. So of various other affec- 
tions in like manner. The great diversity we discover 
in epidemics, may perhaps be explained upon like prin- 
ciples. Hence from a small change in the predisponent 
principle, arises the great variety in different epidemics. 
This is so much the case, that hardly any two epidemics 
are exactly similar in their appearance. 

I should for the present say, that the predisponent 
cause of the disease under consideration is exerted chief- 
ly upon the pulmonary system ; and that the principal 
agent giving permanency to the exciting cause, is cold. 
This last, however agreeable it may be at certain times 
to balance the effect of too much heat, may be consider- 
ed as very prejudicial to the health of man, under certain 
circumstances. A person may pass through the sickly 
season of almost any epidemic without injury, provided 
he can keep the balance of his system from being broken 
by exciting agents ; the principal of which is the seda- 
tive power of cold ; which by producing a tonic spasm or 
fixed stricture in the finer order of vessels on the sur- 
face and subjacent parts, co-operate with the predispo- 
nent liability ; and commotion and violence in the sys- 
tem is the consequence. The predisponent principle 
operates by producing a peculiar susceptibility in the 
system ; yet of so delicate a nature as hardly to be per- 
ceived by the person affected, and might pass unnoticed 
if not roused into inordinate action by some exciting 
power. The negation of heat lias always a sedative effect 
on the human system, and proves only stimulating, by 
the responding action of the system. 

The irritability of the system operating against so 
great a load of oppression, may be sufficient to account 



SECT. III. L'ERIPNEUMONY. 293 

for the phenomena, which takes place in that state of ac- 
tion called fever; and especially when we consider that 
the operations of nature are not always well directed, 
producing oftentimes fruitless efforts, and such a degree 
of violence as to destroy some essential part, or to ex- 
haust the excitability of the whole. 

It seems to be common to this fever, as also the spot- 
ted fever, for the heart and arteries to act with uncom- 
mon violence in proportion to their ability ; so that there 
is oftentimes much danger of wearing out the excitabi- 
lity of the system in a short space of time, and even be- 
fore there is time for much secondary derangement to 
take place in the organization of the solids, or condition 
of the blood. The heart in common with other muscles, 
cannot endure an action greatly above its common ha- 
bit, without falling back to a state of rest ; and when it 
becomes exhausted of energy, by a preternatural and un- 
common action, this rest is the rest of death ! 

2dly. With respect to the symptoms, they are all such 
as may admit of explanation of changes being made in 
the moving powers of the system, and not depending 
upon any morbid principle in the circulating fluids. 
Languor; lassitude; numbness in the muscles; lanci- 
nating pains in the limbs ; under certain circumstances, 
cold chills ; at other times none, where the depression is 
great; a pain very generally in the side ; sometimes in 
the head, at other times most in the stomach, hypochon- 
dria, or region of the heart. Pain in one side or other 
of the thorax is, with few exceptions, characteristic of 
the disease. I have thought it more commonly in the 
left side, with a continuation through the body to the 
right hypochondrium, but some say most in the right 



29* PERIPNEUMONY. CHAP. VIIc 

In severe cases, the pain is extensive in the side, and is 
attended with a sort of cringing convulsive action of all 
the muscles from the shoulder to the hip. For the most 
part a cough ; that is to say, when the morbid influence 
falls chiefly upon the hronehial vessels ; attended with a 
mucous expectoration, oftentimes highly tinged with 
Wood. At other times, there is an absence of cough 
and expectoration, when the morbid action falls upon 
the external membrane of the lungs, the pleura, the 
heart, the pericardium, or diaphragm. The sensation 
is commonly correct in pointing out the seat of disease 
by the pain in the part ; and also the diagnostic signs 
pretty constantly attend the organ most essentially af- 
fected. 

The first passages seem to be affected only in a secon- 
dary manner ; or at least with the exception of a few 
solitary cases of attack in the stomach. There is not 
discovered a viscid sordes, nor redundancy of bile ; the 
appetite is much better than is common in former fe- 
vers except the last, and the fur upon the tongue is gene- 
rally short and white at the onset ; but grows dark if 
fever continues. The pulse from 80 to 180 in a minute, 
weak, quick, and easily compressed by the touch, at the 
attack ; but generally grows more strong and full, espe- 
cially after moderate evacuations. If the force of the 
disease is broken, the frequency of the pulse diminishes: 
if not, it increases so as not to be counted. 

In short, the symptoms partake of fever in general, 
connected with membranous inflammation, of the inter- 
nal assimilatory organs, and are diversified according to 
the degree of irritability of the subject, the particular 
organ especially attacked in the thorax, and the duration 



SECT. III. TERIPNEUMONY. 2i)£> 

of disease ; so that to detail all the symptoms would he 
a prolix work. It may he sufficient to observe, that the 
local inflammation is not strictly phlegmonic, but is of a 
membranous erytheinatic kind, not very apt to end in 
suppuration; but liable to give from the inflamed mem- 
branes an ichorous purulency into the cavities ; but often- 
times a coagulation of lymph and pus. The termination 
of the disease is usually on one of the days from the 
third to the seventh, generally the fourth ; some end 
fatally in a few hours. 

I would fain turn from the ghastly visage of my pa- 
tient ; from his languid accents; from his moans of dis- 
tress, and calls for help, to the third particular of my 
discourse; which is to try the use of means for his re- 
lief. And here I would firstly observe, that the action 
of the system is rapid, violent, convulsive, and, for the 
most part, decisive, in a very short period of time. 
There is as much difference between the action of the 
system in this disease, and that which takes place in 
what is called typhus fever, as there is between the ra- 
pidity of a tornado, and a gentle zephyrous breeze. 
Hence arises the necessity of using means, that have an 
immediate effect upon the system in producing quies- 
cence of morbid action; such as are of Herculean effica- 
cy, and yet as harmless as the retiring voice of innocence. 

The remedies to oppose this formidable disease are 
for the most part but few, and ready at. our hand ; and 
only need in general a judicious arrangement, and timely 
application to be made effectual. A few medicines are 
all we need, and these few as much as our patient's sto- 
mach will bear. We are already in possession of pow- 
erful agents to affect the human system ; and all that U 



296 PERIPtfEUMONY. CHAP. VII. 

required, is skill to apply them, and seasonably, so as to 
appease or render quiescent morbid irritability, or bring 
back retiring energy to the system. 

As the causes of the disease act upon the nerves, and 
show their morbid influence upon the surface of the 
body by coldness in the first stage, want of perspiration, 
&e. ; the natural indication is to restore warmth and ac- 
tivity to the surface as quickly as possible. I have suc- 
ceeded in this oftentimes in the use of the warm bath. 
It is one of the most powerful agents we can employ : 
whilst at the same time it is safe and agreeable. No- 
thing is more common than for patients to express it, as 
a great luxury. If it does not immediately bring on 
sweating, it invites the circulation to the surface, re- 
lieves external chills and internal pain, and prepares the 
system for the remedies which are soon to follow. Where 
the bath cannot be obtained for immersion, rolling the 
patient several thicknesses in blankets, dipped in warm 
Water, serves as a substitute ; and in obstinate cases 
these will need to be kept on the patient a considerable 
part of the time, though not so extensively. External 
warmth may be applied in many other ways ; but from 
my observation, I should say, that water in a liquid state 
is preferable to that of steam. Warm dry flannel ought 
to be often used alternately with wet.* As the system 
is liable to suffer from a recurrence of torpor with cold- 
ness of the extremities and distress, it will be often ne- 
cessary to wrap the legs and arms up in clothes dipped 
in warm liquor, such as soap suds, &c. repeated at inter- 
vals for a considerable length of time. 

* See Chap. v. Sect. 1. note on Jenning's apparatus for con. 
veying the gas of burning alcohol. 



T. III. I'F.KIPNKUMONY. 297 

The next remedy in succession is blood-letting ; this 
ought to be practised early, and in proportion to the pain 
and distress, without having much regard to the small- 
ness of the pulse. We are ready to he deceived by the 
lowness of the pulse, and impute it to inanition, when it 
occurs from oppression, with torpor and congestion. 
Taking blood in such a case is sure to relieve the pres- 
sure of a heavy volume upon the heart and arteries, 
whereby the heart acts with new energy ; and not only 
this, but as the blood is every where receding 1o the lar- 
ger vessels internally, the head suffers by some compres- 
sion in the brain. Taking of blood relieves this,whereby 
nervous energy is imparted more freely to enable the 
heart to sustain itself under the weight and pressure of 
the volume of blood, which cannot as yet be transmitted 
through the capillary vessels. By one common bleeding 
the circulation is promoted, and the system begius to 
emerge from a deep state of depression ; and a sure sign 
of its good effects is, the patient is relieved from chills 
and coldness in the extremities. I have no hesitation in 
saying, that taking of blood, in the disease under consi- 
deration, is of more efficacy in removing cold chills and 
numbness, than all the alexipharmie and sudorific medi- 
cines that can be given.* 

* In Chap. ii. under the year 1814, is a short notice of the 
alarming disease, which is " now desolating many places not 
far from the city of Washington." It appears, that the same 
collision of opinion exists there respecting the disease, as did 
here in the winter of 1812 — 13. Indeed if the disease is not 
the same, it is attended with the same symptoms of extreme 
depression and sudden fatality. Doctors Trent and Hunt 
speak with much confidence in the use of blood-letting with 
external warmth in u disarming the disease of its terrors." 



29S PERIVNKUMUM. CHAP. Vli. 

Bleeding ought to be repeated, as the pain and pres- 
sure in the lungs may require; it ought to he repeated 
until the objeet is attained for which we bleed, without 
regard to apparent debility. After the first mitigation 
of symptoms, if there should be a return of pain with 
only a moderate hardness of the pulse, it ought still to J>e 
repeated, until we have bled to the point of relaxation ; 
that is, until an easy balance is established between the 
action of the heart and larger arteries, and the resistance 
in the capillary vessels. The bleeding ought to be prac- 
tised early, before the blood is driven into the capillary 
and pellucid vessels in the membranes of the internal 
organs, which will render the cure difficult, and perhaps 
leave the patient, if he should survive the shock of the 
disease, in a state of chronic ailment. It is common for 
patients to be faint upon the first bleeding, and bear af- 

Dr. Hunt says, "in some cases of great depression of the 
pulse, I have found it necessary to use bleeding six or eight 
times during the day, when the pulse would recover its elasti- 
city, and the lancet then may be used, as freely and success- 
fully as in common pleurisy." At the same time and in the 
same vicinity, a Dr. Martin, in reply, says, " But I wish it 
to be known, that all the remedies you have recommended, 
such as bleeding at any stage of the disease, or purging, 
not only hastened the patient out of the world, but actually 
brought on dissolution by death /" &c. The remedies pro- 
posed are laudanum, spirits, snakeroot, sweating, &c. His 
words are, these measures " sometimes terminate the complaint 
in twenty-four hours, more or less'* As a specimen of this 
" benighted traveller's" success in treating epidemic fevers, may 
be noticed his own statement of an epidemic, in his own 
parish, in the winter of 1812 — 13, "in the space of five 
months, out of a population of 1500 souls, in that short 
space of time, not less than 500 persons died." ! ! 

Rational Intelligencer, of Feb, 9. 1815, 



SECT. III. PERIPNEVMONY. 299 

ter bleedings well. The pulse rises upon blood being 
taken, and shows more distinct inflammatory action. 
The bleeding must be continued and repeated early in 
the paroxysm of fever, until the object is obtained for 
which we bleed. I am always glad if one bleeding will 
cure my patient : if not, I would bleed to seven times, full 
bleedings, if need be. I have seldom, the season past, 
had to go further than four full bleedings ;* and as many 
as this, I have practised in a large proportion of my pa- 
tients. In my own ease, I was bled four times, and never 
gained ease that was any how tolerable until the last 
time ; when I perceived by my feelings instantly, that I 
bad gained the point of relaxation from pain, the blood 
was stopped ; and this was the end of extreme distress. 
From an erroneous apprehension, that it will not do to 
bleed in what we call spotted fever, many who consider 
the present epidemic as having an affinity to this, have 
been much reserved in the use of the lancet, and have 
thought a very little bleeding sufficient. A little bleed- 
iug only gives room for the system to rise into high arte- 
rial action ; aud I have thought it better not to bleed at 
all, than to bleed only half enough. Dr. Moseley says, 
" The intention of bleeding can be answered only by per- 
forming if immediately, and in the most extensive man- 
ner, which the high state of inflammation and the rapid 
progress of the disease demand. Taking away only six: 
or eight ounces of blood, because the patient is faint, 
which is a symptom of the disease, is doing nothing to- 
wards a cure; it is like Erasistratus giving three drops 

" A full bleeding in an adult may be considered to be 
about eighteen ounces, often mors; or so much as mitigates 
pain, and makes an alteration in the pulse. 



300 FERirJVELMONY. GHAP. VII. 

of wine, justly ridiculed by Cclsus. When bleeding is 
improper, no blood should be taken ; where it is proper, 
that quantity cannot relieve ; and it is losing time which 
cannot be regained." 

If the bleedings are not practised early, the system 
suffers from the excitability thereof being exhausted ; 
the patient sinks into an irretrievable condition ,• at least 
be passes into a state of indirect debility, which is gene- 
rally beyond the control of remedies. 

At other times when bleedings have been practised to 
a tolerable extent, yet not to the degree of manifest re- 
lief, they may be repeated to a great degree, even at a 
late period of the disease; if done before indirect debi- 
lity has actually commenced. A young man, S. M. 
about twenty, had laboured under a severe attack of the 
epidemic four days ; he had been bled pretty freely three 
times by the attending physician, but relief was not gain- 
ed ; at this period I firs_t saw him at the latter part of 
the night. The smallness and amazing rapidity of his 
pulse, estimated by the attending physician at 180 in a 
minute, the extreme short and hurried respiration, the 
universal distress, especially the pain in the whole of the 
left side of the body, with a livid countenance, and spasms 
in the diaphragm, forbade every hope in himself and those 
present, that he could continue but ior a short time. He 
was immediately invested in three bed blankets, wrung 
out of warm water ; after continuing about thirty mi- 
nutes in this warm fomentation, he began, to have a more 
florid countenance and better circulation. He was then 
bled in the hand ; it continued bleeding moderately a long 
time. The manner of taking the blood made it impos- 
sible to ascertain the quantity ; I should judge not less 



SECT. HI. l'KKll'NEUMONY. 3Ui 

than a wine quart. I was guided not by the quantity but 
b\ the pulse ; and as soon as a manifest change to soft- 
ness with faltering in the pulse was discovered, the blood 
was slopped. In a short time, say one hour, he was 
manifestly relieved ; and when I saw him the next day, 
free from distress; and recovered in the use of tiie most 
simple measures, and almost without taking any medi- 
cine. 

The principle was fully and satisfactorily experiment- 
ed in one family where seven had the disease in a charac- 
teristic manner. Two of them treated in the al-a-mode 
of the t\,\y ; opium, calomel, pukes, neglect of bleeding, 
ecc. ; boih paid the debt of nature. The other five were 
treated in I he fullest extent of the principles now ad- 
vanced. Tiiey were bled as the cases required ; some 
four times. All had a speedy recovery. In the cases of 
two aged women in other families, one about seventy, 
the other about eighty years of age; each of them bled 
twice, and had prosperous recoveries. Cases might be 
multiplied. The temporizing, halfway practice of little 
bleeding, little opium, little of every thing, is most in- 
sufferable, in severe cases. 

Whilst bleeding is practised according to the nature 
of the ease ; the external means heretofore mentioned, 
ought to be more or less persisted in, according to the 
feelings of the patient, and along with these, frictions 
and blistering, with a view of equalizing action atid di- 
verting the circulation from the internal membranes, the 
seat oi' danger, to the surface of the body. 

For the same purpose mild sudorilics should be per- 
sisted in, such as infusions of pleasant aromatic herbs, 
essences, &c. Care should be taken, that the stomach 



o'0.Z PERIPNEUMONY. CHAP. Vll. 

is not more offended with nauseous drinks and medicine, 
than is really necessary, but it should be supplied with 
substances agreeably nutritious. It may be observed, 
that this organ is not the seat of the disease ; or in other 
words, there is not contained in the stomach, or biliary 
passages, any exciting cause of the disease. The affec- 
tions of this organ are sympathetic from impressions 
made on the membranes of the skin, lungs, &c. The 
nausea and sometimes puking, which frequently take 
place, no more require emetics, than that kind of puk- 
ing, which attends a fractured skull, by compressing the 
brain ; I mean for the purpose of relieving the nausea ; 
but moderate emetics may be, and have been useful, by 
relieving the lungs ; and for this purpose it has succeeded 
best with me, to give just enough of the tartarized anti- 
mony to bring about one or two pukings, once or perhaps 
twice in twenty-four hours. They may be useful some- 
times in habits not very irritable, in promoting diaphore- 
sis ; but they are hardly to be trusted ; and do not suc- 
ceed so well in this respect as external warmth with 
agreeable sudorifics. 

Emetics are most useful when the locality is princi- 
pally confined to the internal or bronchial membranes of 
the lungs, whereby mucus is afforded and needs expecto- 
rating. They are often of hurtful tendency in other 
conditions of locality, as when it is principally in the 
heart, &e.* I submit to the candid judgment of those, 

* In a communication from Dr. Bowen, of Reading, on this 
epidemic, mention is made, that the people had gained an im- 
pression from some " newspaper publications" in favour of 
emetics in spotted fever, that many families had a supply at 
hand, and as soon as one complained, " down went an emetic. 
This was a pernicious practice, and unrcss accompanied with 



SECT. III. FERIPflEUMONY. 303 

who have seen much of the exhibition of emetics in the 
disease under consideration, whether they have not seen 
an alarming train of consequences from their use, which 
do not necessarily attend the regular course of it ? Much 
nauseating or offensive medicines of any kind are impro- 
per, the stomach needs agreeable refreshment, as is 
manifested by a greater desire for it, than is discoverable 
in almost any other fever. I am certain I have seen, 
and not only this, have experienced the most salutary 
effects from the use of rich agreeable broths, and other 
articles of nutriment. Where the stomach is disturbed 
by disagreeable medicines, it is deprived of the use of 
these; and the patient suffers from the want of that 
energy which they impart. 

The only error, I am conscious of having committed 
in the management of my own ease,* was the taking of 

external warmth, so as to produce sweating, never fails to 
aggravate the disease. Two died in the operation. " 

Another circumstance related by this correspondent may be 
inserted in this place, as illustrative of the correctness of the 
principles here advanced for the cure of this disease. He says, 
"there were two symptoms in this disease, which often occur- 
red, and whether separate or combined, always in my practice 
foretold a recovery: viz. a spontaneous hemorrhage from the 
nose, or a swelling of the face about the eyes, generally on 
one side only; occurring the third, fourth, or fifth day of the 
disease. Some would be swollen so as to be blind for several 
days. The swellings appeared to be the oedema erysipelatoi- 
dis. They were both encouraged in my practice by heat and 
moisture. These symptoms mostly occurred in the milder 
forms of the disease ; however they appeared in four or five 
severe cases." 

* Allusions to my own sickness in many respects are un- 
pleasant ; but certain circumstances seemed to render it neces» 
sary at the time this communication was made. Perhaps the 



$04 I'tiRlPNEUMONl. CHAP. VII. 

a common dose of an emetic, the day after I had taken 
a moderate one; the first gave me no sensible relief; 
the nausea continuing, another was taken next day; 
no relief was gained from this, nothing was brought up 
but what might be expected in a state of health; and 
I found myself after four or five operations near a state 
of dissolution. The stomach did not respond to the ac- 
tion of the emetic in the usual way ; and what was rais- 
ed, was by a sort of convulsive throw, and passed through 
the esophagus by the force given it in the stomach, with- 
out any perceptible action from the coats of this passage. 
All restraint of the first passages was gone. At this 
momentous crisis, a table spoonful of generous wine was 
takei ; I well remember the difficulty in swallowing it, 
and the invigorating power it imparted to the whole 
system, the stomach in particular. This was followed 
by the most agreeable broth; and soon after by more 
solid food ; notwithstanding the disease was still severe. 
Nothing was taken of a directly stimulating quality but 
a few spoonfuls of wine. 

circumstances, in part, exist, which might warrant the repeti- 
tion here. Notwithstanding, if they could be dissevered with- 
out maring the integral connection of the discourse, it would 
have been done. The attack was on the night of the 26th of 
February. A severe impression was perceived in riding in an 
open sleigh against the north wind. One garment usually 
worn, was omitted from the circumstance of its being an un- 
commonly pleasant day. The wind was felt more than was 
expected, and the very hour can be designated, that the im- 
pression was made; although symptoms of severity did not 
commence until about ten hours after. The case was consider- 
ed by all a very severe one. 



»LCT. III. FEKIFXEUMONY. SO* 

Moderate cathartics are often proper, and in some 
i-ous liabits they may be made more drastic by the 
addition of calomel. My observations lead me to believe, 
that the natural purging salts are preferable to the more 
heating drastic purgatives ; these, if given too freely, 
arc apt to hurt the appetite ; and it is a fortunate cir- 
cumstance, that if the other parts of the curative means 
are attended to, they seldom need to be repeated. After 
the warm bath, with bleeding, blistering, 6cc. had been 
gone through with in my own case, as also a dose or two 
of calomel as a cathartic, without relief, I directed an 
infusion of rhubarb and common sulphate of soda to be 
prepared : this was taken freely, and had an effect in the 
course of the day. The operations were followed by 
drinking freely of scalded milk and water, and sometimes 
with the addition to this of elm tea and sugar. Between 
three and four quarts were taken of this drink, in the 
course of the afternoon, and with great luxury, as thirst 
was present. The distress and heat in the stomach and 
bowels were entirely overcome, and had no return during 
the time of confinement, which was about fourteen days 
after taking the portion ; and during the time of con- 
valescence, I made no use of cathartic medicine. 

Occasion has been had already to speak of sudorifics, 
in part; but as they claim so high a rank in the scale of 
remedies, it becomes necessary to observe, that our chief 
attention should be directed to the accomplishment of 
this object. If there was nothing more to be done than 
is necessary to bring on a sweat upon a healthy person, 
it might be easily accomplished ; — but when we con- 
sider, that in bringing this about, we have to contend 
against the whole weight of the disease, it becomes diffi- 

39 



i06 PERIPNEUMONIA. CHAP. VII. 

cult. It is frequently \c\y dangerous to continue exter- 
nal warmth and internal means, in order to effect this 
objeet, when they do not have the desired effect, by rea- 
son of too much inflammatory aetion on the skin, which 
sometimes happens. In this case blood-letting is the safest 
and most effectual of all means to induce a diaphoresis. 
If all circumstances are equal, I make a point of bleed- 
ing my patients, until a sweat will follow by the use of 
gentle means. But the great diversity of habits we meet 
with, and adverse circumstances often attending the state 
of disease, renders it necessary, that we employ every 
rational means to accomplish so desirable an objeet. 
The common seneka has succeeded with me the most 
effectually of any direct, sudorific that I have seen used. 
The sixth day of disease in my own case, I took about 
six grains of the powder every three hours, by the sug- 
gestion of Dr. Perkins of H mover; I at first hesitated, 
fearing it might disturb my stomach. Although I had 
sweat freely for several days in the commencement of 
the disease, and the inflammatory action in the system 
subdued as to any degree of violence ; yet my skin felt 
to myself hard and dry like a covering of paper. Upon 
taking the first powder, warm bricks and additional co- 
vering being applied, I perceived a new r sensation com- 
mence in my throat, lungs, and all over me; and in 
fifteen minutes broke out into a sweat. The state of my 
skin was from that time changed. The sweat was con- 
tinued freely about twelve hours, with much benefit; 
recourse was had to the same means afterwards, as occa- 
sion required. I have used this article many times with 
manifest benefit amougst my patients. Perhaps many 
other simples might have answered the same intention. 



BE<JT. III. I'EKIl'xVEUMONT. 407 

Many respectable physicians s])eak highly of the sail- 
gilinaria or common blood-root; I am not prepared to 
gitfe an opinion at present on this subject. 

In various stages and conditions of the disease, benefit 
was received from the steam of warm water, or an infu- 
sion of emollient herbs, applied by mean's of a common 
tea-pot, placed uncovered a little below the neck of the 
patient, as he lays in bed ; and the steam so managed as 
not to oppress the patient, and by a slight covering 
spread over the head, permit him to inhale the vapour in 
a very mild form. 

Many other remedies of a less important nature have 
been used, with some advantage, in the different stages 
of the disease ; such as warm infusions of sage, horse- 
mint, pennyroyal, saffron, balm, &e. To these might be 
add d the small and agreeable essences, ccc. When heat 
and thirst are present ; nitre and camphor, sulphuric 
acid, cream of tartar, vitriolated tartar, soda, magnesia, 
sweet spirit of nitre, &c. Also might be mentioned flax- 
seed, and slippery elm teas, syrup of onions, squills, &c. 
But as my design was to touch upon the more impor- 
tant circumstances of the disease and remedies, I shall 
pass these and some others of less note in silence, as I 
have many of the attending symptoms in the different 
states of the disease. 

One further condition of the disease, however, presents 
itself well worth particular attention : a state of debility 
or sinking, whether induced by too great evacuations, or 
a recurrence of quiescence in the action of the system 
from a return of torpor, or admission of cold to the sur- 
face ; in which case, there is a faltering of the pulse, and 
perhaps a sympathetic spasmodic puking, with imminent 



308 PEUIFNEUMONY. CHAP. VII. 

danger of dissolution. In such a case opium is some- 
times useful, and may be given in considerable quanti- 
ties; likewise ether, alcohol, &c. The following has 
been very useful. 

R. Cort. Peru. (bark) 2 drachms. 

Pimento (allspice) 1 do. 

Sach. Alb. (loaf sugar) 4 do. 

Spir. Vin. (brandy) 4 oz, 

Give a table spoonful every four or six minutes, or ac- 
cording to circumstances; a little warm water may be 
added, if most agreeable to the patient. 

The chance of success in such cases depends upon the 
quickness of the pulse. If the pulse is slow, the success 
may be speedy and complete ; if quick, the success may 
be more doubtful. The most urgent necessity alone can 
justify the giving of opium, even in this state, where the 
pulse is very quick, say 120 pulsations or more in a mi- 
nute. It shows, that the cause of the disease is not yet 
overcome by right remedies ; and in every instance wbere 
opium is given during a state of oppressed action, and 
before the inflammatory state of the system is subdued, it 
is manifestly hurtful ; and nothing can justify its exhibi- 
tion but some sudden emergency to preserve life for the 
moment. In either case, wine, alcohol, and ether should 
in part supply the place of opium. I have not had occa- 
sion to use opium in any form, I should say, in more than 
one case in 15 or 20 of my patients, and with a few excep- 
tions, in the most reserved manner. It must be kept in 
mind, that whilst these remedies are used, they should 
be accompanied with external warmth. Cloths dipped 
in warm soap suds or warm spirit, may be applied exten- 
sively to the limbs* 



SECT. 1IT. PEUIPNEIMONY. J09 

Whilst speaking of the use of opium, calomel is 
brought to my mind by a kind of association of ideas. It 
will be mentioned only for the purpose of putting it in 
the back ground, as a corps-de-reserve, not to be call- 
ed into action. I speak of it as an alterant; it may be 
useful as an evacuant along with other cathartics ; but 
here it is chiefly useful in proportion as it evacuates, and 
other articles may well supply its place. If attempted 
as an alterant, it either has not time to affect the lym- 
phatic system, or if it does, serves only to irritate the 
inflammatory state of the blood-vessels. To make the 
most we can of mercury, it is dilatory in its operation ; 
and in a disease, which proves fatal in four days, often- 
times less, it is but little consolation to friends to be told, 
that if mercurial action had been brought on, the pa- 
tient would have survived. If it has time to affect the 
lymphatic s>s<em in protracted cases, it does not give 
the expected relief; and oftentimes the pain, soreness, 
and distress are worse than the disease it was intended 
to cure. It is of hurtful tendency in another point of 
view ; in the use of this, other remedies are often neg- 
lected of primary importance, and time spent, that can- 
not be recalled.* 

Thus, gentlemen, have I given a short and imperfect 
sketch of my views and treatment of the late alarming 
epidemic; drawn up in a hasty manner, and in need of 
much explanation. If it is my lot to be of a different 
opinion from some of my brethren, I only ask that they 

* This paragraph and some other observations are rather 
repetitions of the same subject in other chapters, but it was 
thought best not to dissever the original connection of the dis- 
course. Some further observations on the disease may be seen 
in Chap. u. under the year 1813. 



PEKir.VEUMONY. CHAP. VII. 

atUI exercise the same forbearance towards me, which I 
feel to exercise Cowards them : and l-vitv conflict that 
may arise, to be considered as a conflict of opinion, and 
nothing to be construed as personal, or in any manner 
affecting the reputation of individual?. Truth ought to 
be our pursuit : aud whatever errours may be attached to 
me. I am willing they should be rescinded. 

0:ie further consideration presents itself to view.which 

aid be willing to pass in silence, did not imperious 
necessity seem to demand attention to a short statement 
of the result of my practice, founded on the foregoing 
observations. I am deficient in one particular in this 
respect, in not having kept a journal; and shall there- 
fore state in general terms, according to the be=t of mj 
recollection, with the help of my family; aud say. that 
from the middle of December last to the present time, 

umber of cases that I have had the control of. in 
the course of the disease, must be somewhere between 
one hundred and fifty and two hundred : meaning eases 
of attack of the epidemic fever, although some of them 
had not the peculiar pneumonic* affection: The seat of 

affection in the head., or what is some- 

men : jffet the greater part had 

nation. I do not include in 

this number cases I may have visited in consultation with 

physicians : bnt where others we visited my 

lein ray patients, and under my 
ol as it relates to the 1 -at. But if I may have 

taken the charge of a er being attended by ano- 

ther physician ail this my patient, although I 

may have had ehai But I will here ob- 

serve, that tL rogpng of car 



SECT. III. PERIPNEUMONIA ;U1 

our neighbourhood for the winter past, so far as my 
observation goes. I will say then upon this mode of 
reckoning! uiy calculation of the number of eases must be 
moderate ; for I laboured hard except in the time of my 
own confinement; and in some part of this, was able to 
give directions to my pupils, who attended several in this 
way without a failure. Taking the matter then in this 
point of view, I can say, through Divine blessing, I have 
lost only two patients; one in December, an aged woman, 
whose memory is ever dear to me. I visited her first 
and the only time, twenty-four hours after the attack, 
when every symptom beclouded every hope of recovery. 
The other a little boy, died day before yesterday ; I saw 
him the day after the attack, when a violent arterial 
action had began to subside into a weak, quick, arterial 
action, of the typhoid character. 

Brethren. Though we have been surrounded with 
clouds and thick darkness, and afflictions have come near 
us ; yet let us join in ascriptions of praise and thanks- 
giving to Him, who directeth the pestilence that wasteth 
at noon day, for our preservation, and the opportunity 
we have of meeting this day, for social intercourse, 
and improvement in medical science. 



CHAPTER VIII. 



ON DYSENTERY. 



" And fluxes dire, 

With suffocating pain, and thirst, and spasm, 
Distract the man of hope.'* 

SECTION I. 

Preliminary observations. 

The name is well enough ; it conveys no idea of noso- 
logical character; merely signifying a had or diseased 
state of the intestines. Its having so constantly a fixed 
locality, has induced some to call it a local disease ; and 
its being sometimes attended with a want of heat on the 
surface of the body, has led superficial observers to con- 
sider it as destitute of the character of fever. But it 
must be a waste of time to undertake to prove that it 
holds a high rank in the scale of epidemics, and that it is 
as much entitled to the appellation of fever, as the plague 
is; and may not unfitly be called the plague in the 
bowels. 

It will only in this place be noticed, without troubling 
the reader with numerous references to facts, that fevers 
of different characters have prevailed, previous, at the 
same time, and immediately after, when dysentery has 
prevailed ; and it is a common circumstance for the dis- 
ease to begin with fever, and after an uncertain time to 



SECT. I. DYSENTERY. SIS 

change into dysentery ; and again for dysentery to change 
into continued fef er. This establishes the identity of a 
general diseased impression ; and also proves, that a 
translation of local affection changes the habit of disease. 
"When the general and local predisponent causes are ab- 
sent, it is a very difficult thing to make a dysentery. A 
diarrhoea may be induced by obstructed perspiration, ca- 
thartics, &c. When these causes are present, the slight- 
est variation of external circumstances is apt to ex- 
cite the disease. In the epidemic seasons of dysentery, 
the same laws seem to be regarded, as in other epide- 
mics with respect to its spreading, becoming extinct, &c. 
and which were adverted to in Chap. in. The circum- 
stances of heat and cold, drought aud moisture, have no 
further concern in this case than acting as exciting cau- 
ses ,• except so far as they contribute iu producing the 
local dysenteric miasmata, in conjunction with collateral 
circumstances. 

It usually makes its appearance in the months of July, 
August, and September. I have known it very conside- 
rably prevalent as an epidemic in March and April. It 
is the most constantly attending epidemic, or in this view 
endemic, that affects the people of America. Not a sea- 
son passes but it is heard of in some place or other, even 
in this state. Its fatality at certain times and in certain 
places is astonishing. It stalks over the whole earth ; 
and probably has destroyed more of its inhabitants than 
any other disease except the plague. " In 1316, raged a 
desolating dysentery in England, accompanied with an 
acute fever, which, like the true plague, left scarcely 
survivors to bury the dead." — Webster. The same may 

40 



314 lUfSBNTERT. CHAP. VIII. 

be said of many other times and places. Tt is particu- 
larly common and fatal in camps. " The page of mili- 
tary history weeps less for the slain in battle, than for 
those who have fallen victims to this calamity." — Mose- 
ley. 

The symptoms of this peculiar locality of disease are 
so well kuown to every body, from the frequent recur- 
rence of the disease, and so minutely described by nume- 
rous writers, that but little seems necessary to be said 
in this place concerning them. One circumstance of 
Importance appears necessary to be kept in view ; which 
is, to distinguish between the symptoms connected with 
the attack, and first stage of the disease, and those which 
are the consequence of changes made afterwards in the 
intestines in the course of disease. For want of this dis- 
crimination, great confusion has seemed to prevail, not 
only in the opinions of practitioners, but amongst writers 
on the disease. The most preposterous and contradic- 
tory remedies have been proposed and practised ; and 
certain remedies which have been from experience found 
useful in the latter stages of protracted cases, have been 
applied in the first instance, to the great detriment of the 
patient. 

To mention only a few of these may be sufficient to 
establish the position. Concretions of heterogeneous 
matter have been discovered sometimes in cases of some 
continuance, and when present should be removed by ca- 
thartics. Upon the discovery of these scybala, it has 
been apprehended by some writers, that they were the 
principal cause of the disease ; and in consequence of 
this opinion, the poor patients have had to endure the 



SECT. I. MYSENTERY. 315 

distress of repeated cathartics; whereby an artificial 
flux is added to that which is already insupportable from 
the disease* Again ; opium, asl i ingents, and spirits have 
actually been useful, discreetly managed after the fever 
and inflammation have principally abated in protracted 
cases. In consequeuee of this beneficial effect, they have 
often been used in the beginning of the disease, to the 
great injury of the patient. 

Another circumstance must be adverted to, which is 
in its nature almost unpardonable. On dissection the 
intestines have sometimes been found in a gangrenous 
condition. For the purpose of attempting to avoid this* 
remedies have been early used, possessing what are call- 
ed antiseptic qualities ; these are almost wholly such as 
aggravate and increase inflammation. Now as it is de- 
monstrable beyond all contradiction that this disease is 
an inflammation of the coats of the intestines, and con- 
nected with general fever as much as any other epidemic 
disease ; also it being very manifest that the gangrenous 
state of the bowels is preceded by inflammation, which 
terminates in mortification, the fatal tendency of these 
measures is made manifest. If instead of opium, wine? 
bark, and the dread of blood-letting, the reverse of these, 
with diaphoretics were used, and inflammation suppres- 
sed, the dreaded gangrene would almost certainly be 
avoided. It is very curious to hear a fellow of the Edin- 
burgh College of Physicians,* whose collections are 
sometimes appealed to with respect, assert in this dis- 
ease, when speaking of inflammation, that it rarely oc- 
curs. " When it does attend dysentery, it is the conse- 
quence, not the cause of the disease ; and therefore 

* Dr. Wilson, page 432, vol. ii. 



316 HYSENTEltl. CHAP. VIII. 

seldom supervenes early." " Instead therefore of let- 
ting blood in all cases where the strength can bear it, it 
will be found a maxim better supported by experience, 
to avoid it, whenever the symptoms can be otherwise 
allayed." 

It has always been the misfortune of the science of 
medicine, that maxims and precepts have oftener been 
imposed from some eminent lucubratory of abstract spe- 
culation, than from the humble retreats of clinical obser- 
vation. In opposition to what has just been advanced, 
stand the opinions of a great many writers of reputation ; 
to mention Lieutaud, Likenside, D. Monro, Moseley, 
and Rush, would be naming only a few. But we are go- 
ing beyond our design. If so, we must observe a little 
further, that our author asserts, " inflammation of the 
intestines is known here, as in other eases, by the great 
severity of the pain and tenderness of the abdomen, 
and by a frequent, small, feeble pulse, more or less hard ; 
symptoms which warrant blood-letting at all periods ex- 
cept the last stage." It must be acknowledged by every 
practitioner, much conversant with this disease in a 
severe form, that these symptoms are very obvious, even 
on the first day of the disease. And it will be asserted 
that they require blood-letting at any stage or period. 

The great misfortune in all this business is, that the 
only safe remedies must be omitted until we find our pa- 
tient sinking in death. For we are told, «« the tendency 
to gangrene is often so great, that it supervenes on a de- 
gree of inflammation too slight materially to affect the 
state of the symptoms." 

But the fact is altogether different. It is inflammation 
from the first } as much so as that state of disease last 



SECT. IT, DYSENTERY. 317 

mentioned in the membranes of (he thorax. The evil 
Attending ii all, is the degree of inflammation and its fa- 
tal tendency are not recognised, until that flood of evi- 
dence is produced which marks the violence of a disease, 
which cannot now be controlled by proper remedies. 

But this disease does not always terminate in gan- 
grene, when it proves fatal. It terminates fatally some- 
times in a few hours, like other severe epidemic diseases. 
In the seasons of epidemic dysentery, which has prevail- 
ed in this section of the country a few years past, and 
before the spotted fever prevailed, it was frequently the 
case, that the disease would terminate unfortunately in 
twenty-four or forty-eight hours. Upon dissection, no 
traits of gangrene were discoverable at even a later peri- 
od. As this chapter is devoted to miscellaneous observa- 
tions, without any thing like systematic arrangement, it 
might be acceptable to insert a sketch on this disease, 
which I made in August, 1802, containing three cases of 
dissection, and which was put in the public print at that 
time. The practice proposed has ever since answered 
my most sanguine expectations, in general terms. 

SECTION II. 

Dissections, and treatment of Dysentei^y. 

"After searching for the best, and trying most of the 
measures recommended by authors and practitioners, the 
conviction was impressed upon my mind, that little in- 
deed was the benefit obtained by the common method of 
practice, although as large a number of my patients re- 
covered as that of others. Under these embarrassments, 
in the year 1798, 1 determined by strict inquiry to form 



318 DYSENTERY. CHAP. Till. 

a mode of treatment more to my satisfaction, if possible. 
I accordingly obtained leave to inspect tbe bodies of two 
that season, who died of this disease ; the appearances 
of which I shall here insert. 

Case i — Was a boy of sixteen months old, who died 
the sixth day of the disease, with all the common symp- 
toms of dysentery, viz. some vomiting, frequent purging 
of bloody mucous matter, with pain and tenesmus; fever 
with a small quick pulse ; and although purging was " as- 
siduously employed," no hardened faeces were ejected. 
Upon laying open the thorax, nothing preternatural was 
discovered. In the abdomen, the omentum, stomach, 
intestines, and liver, appeared natural and entire. After 
detaching the intestines, and beginning at the bottom of 
the rectum to lay them open., the seat of the disease ap- 
peared, viz. in the internal membrane of the colon and 
rectum through their whole extent to the ccecum. The 
external coat was not altered much, except a turgescence 
in the mesenteric blood-vessels; but the inner one was 
greatly fretted, inflamed, and abraded, apparently ex- 
tending into the muscular coat, with innumerable red 
specks or points, from which probably issued the blood 
that was ejected ; the red specks were very contiguous, 
insomuch that the membrane had almost the appearance 
of a red or inflamed surface overspread with a coat of 
mucus, or rather sanies ; upon scraping oflf this sanious 
mucus, the red points became distinct. There was 
nothing in the whole tract of the stomach and intestines, 
except a very small quantity of the same kind of matter 
which was evacuated per anum, and one worm. The 
intestines were distended to full their natural size with 
air. 



SECT. II. DTSENTERT. 319 

Case ii — Was a boy a little older than the former: 
he died about the fourth day of the disease, without tak- 
ing scarcely any medicine, and no cathartics. The 
appearance upon dissection was very nearly like the for- 
mer; his bowels being about as empty as the former, 
and moderately distended with air. The whole tract of 
the internal membrane of the colon and rectum exhibited 
one continued abraded or superficially ulcerated surface, 
with the same appearance of spots, &c. There was no 
obstruction nor constriction, nor any signs that there ever 
had been, in this, or the former case. 

Case hi. This present week I inspected the body of 
a child, nearly two years old, which died of the dysente- 
ry on the 7th day of the disease, in which the common 
evacuant method had been pursued. The appearance 
was very similar to the preceding, except the abrasion or 
membranous inflammation was more extensive, but not 
quite so violent in the lower part. Spots a9 before ; a 
slight redness perceived in the external membrane of the 
intestines, and mesenteric blood vessels very turgid with 
blood.* 

The appearance in these dissections gave a different 
turn to my reflections on the pathology and cure of the 
disease. I could not conceive why, in such an empty and 
irritated state of the intestines, cathartics, so common- 
ly inculcated and practised, should be useful, by being 

* It may be remarked, that the membranous inflammation 
is not always strictly confined to the inner coats of the 
rectum and colon ; I have seen portions of the small intes- 
tines and stomach slightly inflamed. Authors relate cases 
of the small intestines, stomach, and even liver being highly 
inflamed, and even mortified. As cases of other disease show 
sometimes a more extensive affection, so this may be more 
widely diffused. 



320 DYSENTERY. CHAT. Till. 

repealed at the commencement of the disease. Although 
so commonly used, I seldom ever knew an instance of 
their utility, and by lowering the vigour of the system, 
and increasing the afflux of humours to the internal parts, 
have known them do hurt. As to the scybala or har- 
dened fseces, that are said to require them, 1 believe their 
existence to be a rare occurrence, and when present, 
rather the effect than the cause of the complaint. If the 
sweating method, hereafter mentioned, has been pursued 
properly, the fever abated, and the flux shall still conti- 
nue, there may be ground to suspect that this is the ease, 
when mild cathartics may be proper. 

There is constantly a frvcr connected with this dis- 
ease, but it seldom shows itself outwardly in the usual 
course of it ; the complexion is pale, the eyes sunk, and 
no sweats but those that are cold and clammy; whilst 
internally there is a quick pulse, and burning heat in the 
bowels, with ery thematic inflammation, and irritation 
producing spasmodic pains, &c. 

Br. Sydenham's opinion of the pathology of this dis- 
ease is the most rational of any I have ever seen ; « a 
fever of the season, or of its own kind, turned inward 
upon the intestines."* 

The indication of cure comes in of course ; which is 
to turn back the circulation to the surface of the body, 
by way of revulsion from the intestines. And this must 
be done principally by sweating. 

As far as I have used this method I have rarely found 
any difficulty in speedily removing it, when practised in 

* From what has been suggested in the former chapters, 
our pathological views of this disease, will be sufficiently 
apprehended, and will not need further illustration. 



SECT. II. DYSENTERY. S21 

the beginning of the disease, before the intestines become 
too extensively inflamed, and the patient too low ; when 
properly conducted it precludes the necessity of almost 
any other measures, except such as are adapted to ac- 
company and promote the process of sweating. In less 
than two hours the patient perceives sensible relief, and 
gains strength instead of growing weak by the evacua- 
tion. The sweating must not be done by halves, but 
effectually*. It must be understood that this is in the 
onset of the disease ; if not practised till late in the 
disease, sweating must be more moderate, but conti- 
nued longer. A profuse sweat must be kept up until 
the patient feels complete relief; then moderated a lit- 
tle ; but the patient ought not to be suffered to leave 
his bed, nor the sweating to subside wholly for twenty- 
four or forty-eight hours ; and even then with great cau- 
tiou. External heat and perspiration need to be conti- 
nued sometimes several days. Patients bear it better 
than might be supposed by those not in the habit of ob- 
serving the operation in this disease.* The air in the 
apartment ought not to be too much confined, but suffi- 
cient bed clothes added to keep the warmth, but not too 
greatly burdened with covering if sweat does not flow. 

Sweating should be promoted by internal means ; for 
this purpose give a sudorific powder composed of appro- 
priate portions of ipecacuanha, opium, vitriolated tartar< 
and gum camphor ; this rarely fails when rightly exhi- 
bited of answering the intention. The proportions of 
ipecacuanha ought to be so large as to produce two or 
three emetic operations ; if this does not happen from 

* See Chap. v. Sect. 1. note on Jennings' apparatus for 
conveying the gas of burning alcohol. 

*1 



322 DYSENTERY. CHAP. VIII. 

the first dose, it ought to be repeated in an hour, taking 
care (hat the proportion of opium be only sufficient in 
the whole to moderate the spasms; one small dose is 
usually sufficient. If vomiting does not sufficiently fol- 
low the first dose, the powder may be repeated without 
the opium. A sudorific similar to the above should be 
given every four, six, or eight hours. The object in 
the use of opium is to allay extreme spasm, and arrest 
the disease, so that time may be gained for the use of 
more safe remedies. In the greatest proportion of cases 
it may be dispensed with. 

After, and even during the emelie operation, the pa- 
tient ought to drink plentifully of pleasant warm drinks, 
such as sage, mint, balm, or green teas ; or coffee, water 
gruel, sago, broth, &c. But be sure to take nothing 
cold or acid at this stage of the disease. After the 
sweating has been used some time, emollient drinks will 
be useful, such as an infusion of slippery elm bark, 
comfrey, mallows, &c. as likewise milk and water scald- 
ed together. 

Bleeding is very proper in this disease, and ought to 
be practised, many times, when from the smallness of 
the pulse, it hardly seems indicated. It is very necessary 
to Jake blood, if the patient, upon attempting to sweat 
remains dry, hot, aud restless ; in this case it is the 
best means to promote sweats. Blood should be taken 
until pain is mitigated, and until sweat flows. If blood 
is taken early in the disease, the pulse will most certain- 
ly rise upon its use; and it will need to be suddenly re- 
peated, until the severity of the disease is overcome 
along with sweating and other means. 

In the course of the sweating process, small doses of 
some agreeable stimulus to the stomach may be proper, 



SECT. III. D1SENTERT. 325 

such as oil of rosemary* essence of peppermint, essence of 
box-bei tv, lavender, &c. Other remedies become neces- 
sary in the latter stages of dysentery; but whilst there 
is any fever with quickness of pulse, and inflammation 
present, the above may still be the most eligible method. 

The process of sweating may be objected to by some 
on account of the difficult management ; it is true strict 
attention becomes necessary during the sweating opera- 
tion, to keep children covered, and to conduct the busi- 
ness so as to answer the intention effectually ; but it may- 
be done, and the time will be short, and the necessity of 
going to stool soon removed. It is better to spend twen- 
ty-four hours in strict attention, than to run the hazard 
of having to bestow hard attention for a week or more, 
perhaps unsuccessfully. 

I do not expect that every patient will recover under 
tbis or any other management practised at large ; many 
accidents may happen to divert the proper order of pro- 
cedure ; precious time may be lost in the first onset of 
the disease ; but 1 anticipate with serious expectation 
the time, when it shall be adjudged, that the method of 
revulsion in dysentery by bleeding and sweating, shall 
be deemed of as much benefit to mankind perhaps, as the 
inoculation for the small-pox has been in ameliorating 
that destroyer of millions. Aug. 6, 1802." 

SECTION III. 

Miscellaneous observations; and treatment continued, 

This little scrap had its desired effect. Many people 
informed me afterwards, that they had cured themselves 
or their children in severe cases, by following the sim- 



%Vk DYSENTERY. CHAP. YIIJ. 

pie directions it contained. It lias been spoken favoura- 
bly of by many candid and judicious physicians. One 
lii tie acknowledgment from a friend, to whom I sent a 
copy, will be inserted. "When the dysentery prevailed 
in this town, in 1802, 1 lost the first ten of my patients; 
not one lived until I received your kind and benevolent 
communication, which was strictly adhered to ; and I 
never have lost one since. I never have been in the 
habit of giving cathartics so freely as some in the dysen- 
tery." 

In some seasons the disease rages with a violence but 
little short of the spotted fever, or the yellow fever, or 
even the plague, in certain neighbourhoods or villages. 
Nothing short of the early and most assiduous u»e of 
the remedies of epidemic fever can arrest its fatal ten- 
dency. The circulation must be brought back to the 
surface, and action perpetuated there, and the internal 
inflammation suppressed, or the case will go wrong. 
As in other severe affections of the epidemic kind, the 
time is short, therefore none should be spent in ima- 
ginary conjectures and hopeful expectations. The same 
rules with respect to bleeding and sweating should be 
regarded as in other epidemic diseases. With respect 
to vomiting, it is a little different. This is generally 
proper, and by inverting the spasmodic peristaltic action 
of the intestines gives great relief. It also assists in 
promoting action on the skin. In very weak habits it 
should be employed with caution, especially if spontane- 
ous puking is present. 

In strong habits, a severe emetic of cerated glass of 
antimony, or of tartarized antimony accompanied with 
sweating, will often arrest the disease in a short time, if 



SECT. III. BYSENTERY. i%$ 

early employed. In such eases a severe cathartic by its 
general effect on the system iu restoring equality of ex- 
citement may arrest the disease. But after the disease 
has beeome fixed with inflammation of the intestines, 
sometimes only after a few hours, cathartics should be 
employed with much reserve. The most gentle, oily 
or saline eatharties may he used at long intervals in the 
course of the first ten days or thereabouts ; and nothing 
severe, unless after the force of the disease has in a mea- 
sure subsided, the pain continues, and gives an assurance 
that there may be a lodgment of colluvies, or of harden- 
ed faces in some part of the intestines, perhaps in the 
arch of the colon ; when more active cathartics may be 
proper. In this case an emetic preparation, so managed 
as to have a cathartic operation, may be very useful. 
I have more commonly used the common Glauber's salts 
and rheubarb, infused in a large proportion of water. 
As an eccoprotic, manna and cream of tartar in a large 
proportion of barley water is useful. If castor oil can 
be obtained free from rancidity it will be sometimes 
very proper. 

The appearance of scybala is very rare in this country. 
Perhaps I may have met with them in one ease in an 
hundred. In one communication it is asserted, « that 
in eight years practice, and in more than three hundred 
cases of real dysentery, not a solitary case appeared, 
with or without cathartics, of the scybala spoken of by 
authors." If, however, the true scybala do not appear, 
a colluvies of vitiated matter may occasionally need 
removing, in protracted cases. 

The patient ought to take a large proportion of warm 
bland diluent drinks in this disease, especially in the fore 



226 DYSENTERY. CHAP. VIII. 

part of it. They are of essential service in filling the 
intestines, and washing off depositions of exerementitious 
matter, supplying the absorbents, &c. If the stomach 
will bear nothing more, the patient should try to drink 
simple water as hot as he can sip it. This is most pro- 
per in the first stages of the disease, hut occasionally 
very proper at later periods. 

Warm applications should be continued almost con- 
stantly to the abdomen whilst pain continues; such as 
flat pieces of wood from boiling water, or sometimes 
heated by the fire. Warm bricks, bottles of hot water, 
&c. Some of these should occasionally be applied to 
the perineum, and sometimes to the back. If much heat 
should arise externally, as sometimes happens after the 
first days, these external applications may be omitted. 

Like as in other fevers, the state of action varies," and 
the patient needs, and the appetite designates the neces- 
sity of using liquids of a cold temperature. Accordingly 
after the first process is gone through wiih ; the sick 
will sometimes have a great desire for cold drink, and 
in particular for cold water. When this is the case, it 
may generally be indulged. I have seen the most mani- 
fest benefit from the use of cold water in such cases. 

In the summer of 1811, a few severe cases of dysente- 
ry were met with in this place. In the case of a child 
about sixteen months old, the use of cold water saved it. 
The child had not been under my particular regimen, 
until the third day, and then nothing could be got down 
but cold water. At this time a deathlike coldness over- 
spread its whole body ; it seemed almost ready to expire; 
when cold water was offered, it was taken with avidity. 
It was permitted to take what it would. Several pints 



SECT. III. DYSENTERY. 327 

pere taken in nearly as many hours. It showed signs 
of warmth mid a bitter condition within half an hour; 
but it was not until about four hours that it gained 
natural warmth. It had a speedy recovery without any 
other means. 

At nearly the same time, a woman who had been sick 
seven days, but materially relieved from the violence of 
the disease by bleeding and sweating, was exercised with 
a sensation of intolerable internal heat ; she took large 
quantities of cold water with great relief; and which 
seemed to contribute much to her recovery. 

Whilst relating cases, the following may be briefly 
noticed, as happening the present season. I. P. on a 
journey, and from a place where dysentery had been 
considerably mortal. About twenty-five years, of slender 
habit. 

August 15th, 18ii. Thirty-six hours after being at- 
tacked, had rode ten miles on horse-back with the dis- 
ease upon him. Great pain ; stools every ten minutes, 
resembling beef briue; fever; pulse small, quick, hard, 
120 in a minute; great soreness in the abdomen. Took 
fourteen ounces of blood ; Tart. Antim. and seneka ; 
vomited seven times ; sweated freely. Bathe the bowels 
with balsam anodyne ; flannel around the waist. 

■ 1C. But little abatement of symptoms; took 
sixteen ounces of blood. Sal. Glaub. and rheubarb ; con- 
tinue sweating ; epispastics ; agreeable essences. 

17. Symptoms little abated, slept some. Ca- 
thartic had operated mildly. Soda and gum arabic ; 
small emetic of ipecac. Continue diluents, mucilages, 
bathing bowels with balsam anodyne, and limbs in warm 
water. On account of particular obstacles the warm 



328 UYSENTISRY. CHAP. VIII 

bath was omitted. Elm bark tea. Broth. Promote 
perspiration. 

18. Pain and fever still severe ; bled again ; 

matter voided, dark coloured, and thin, injections of 
elm bark tea and milk. Occuli canrorum. Drinks con- 
tinued. 

19. Pain and tenesmus had been mitigated; but 

returned. To the injections of elm bark tea and milk, 
was added twenty drops of laudanum every six hours; 
they were retained only a few seconds and were repeated 
but a few times. Log wood, terrajapanica, and elm 
bark, boiled in water ; take what the stomach could bear. 

20. Considerably relieved ; fever more diffused 

over the system ; stools less frequent, and not so dark 
coloured, with some mucus for the first time perceived ; 
perspiration continued ; magnesia ; warm application 
constantly applied to the abdomen. 

21. Continues with less distress; stools instead 

of every ten or fifteen minutes, with long sitings, less 
than every hour ; continue the same. Spermaceti and 
sugar. 

22. Same treatment. 

23. Pulse eighty-five; stools about thirty mi- 
nutes. Continue the same ; with small dose of ipecac, 
at evening. Small doses of solution of sacherum saturni 
in water. 

2*. Better. 

25. Convalescent. 

The case was now considered safe, but from the ex- 
treme inflammation, the recovery to health was slow 
although the intestines were not ulcerated. Another 
bleeding was proposed, but as objections were made, it 



SECT. III. DYSENTERY. 329 

was not urged, as he had been bled three times, and the 
chief danger was over ; but I have no doubt but his 
recovery would have been more rapid with it. This 
patient took no opium only a very little with the injec- 
tions. - When inflammation can be overcome in the first 
instance, as in the present ease, we avoid the long cata- 
logue of symptoms, which are recorded as connected 
with this disease in a chronic state, such as ulceration; 
am! above all, gangrene of the iutestiues in the early 
stage. 

It is a fact that this disease, in some of its several 
forms, has been suddenly arrested, when treated effectu- 
ally in the beginning ; and the patient restored to a state 
of ease and convalescence in twenty-four or forty-eight 
hours. But if the inflammation has made considerable 
progress, it must of necessity take longer. 

I am more disposed to reject the use of opiates than 
formerly, and never having any very good opinion of 
them, I now almost entirely reject them. At the begin- 
ning of severe cases, a small dose sometimes is necessa- 
ry to give a little composure whilst other remedies may 
be employed, especially if puking attends. And again, 
after violent inflammation has abated, very small doses, 
ten drops of laudanum night and morning, may allay 
tenesmus ; but often in this case, what is gained for the 
present is lost in the sequel; the patient is commonly 
worse after it. Given with any freedom in severe cases 
of inflammation, they will ensure an unwelcome termina- 
tion. 

Of all the cathartics usually employed, calomel is the 
most improper. It has a peculiar property of inflaming 
the delicate membranes of the stomach and intestines. 

m 



330 DYSENTERY. CHAP. VIII. 

A very popular author* remarks, that calomel " is one 
of the best cathartics in this disease;" and says in the 
same paragraph, «« In many, particularly when taken 
alone, it occasions tenesmus, and I have repeatedly seen 
it induce a temporary dysentery." But I will no more 
blot my book with borrowed absurdities and contradic- 
tions. 

Great diversity exists at different times or seasons, 
when this disease prevails, in the degree of violence and 
its fatal tendency. Sometimes it is a very mild disease ; 
and great numbers are affected and recover without 
much confinement. Most generally, however, it is a 
disease of great severity, hardly inferiour to any that 
affects the people of this region. The local inflamma- 
tion affects organs supplied from the sympathetic nerves ; 
great prostration of the vital principle suddenly ensues ; 
and unless the force of the disease can be quickly divert- 
ed from the intestines, the patient falls suddenly before 
it, as in spotted fever, &c. I have seen as much, or more 
benefit from the sudorific process in this disease as in 
any other whatever. I am willing to declare, as a mat- 
ter of opinion, that the cases of severe prostration of 
vitality cannot be cured without it. And again, the en- 
ergies of the system cannot be drawn forth, and the 
mesenteric congestions relieved without adequate bleed- 
ing. But as in all other diseases, remedies have their 
limits; and those measures which with a judicious ma- 
nagement prove useful in one case, may be hurtful in 
another when not discreetly administered. Hence arises 
the necessity of a competent knowledge of diseased phy- 
syology, which can only be obtained by observation and 
the exercise of the judgment. 

* WilSOR. 



SECT. HI. BYSENTEBY. 331 

The most lucid and interesting writer T have ieen on 
dywto ry it Dr. Moseley. lie is an advocate for bleed- 
ing and sweating to the point of relief, lie says, " When 
I propose a method for the cure of this disease by a course 
of sudorifics, 1 am aware of no objection that can possibly 
attend the novelty of the doctrine; except that it wauts 
the sanction of the fathers of physic, and has to oppose 
the errours and prejudices of custom. " 

The chronic state of this disease, and as connected 
with ulceration, is relived by moderate external warmth ; 
wearing a broad flannel belt around the abdomen ; mild 
cathartics as circumstances require ; using mild nourish- 
ment in a liquid form ; mild astringents ; balsamic sy- 
rups; mucilages; whey ; a rocking bed, ot riding in a 
chaise, &c. I have known the avens-root, caryophyllata, 
boiled in water, to which may be added sugar and milk, 
particularly useful. 

"With respect to the contagiousness of dysentery, it 
will only be observed, that evidence of an assimilating or 
fermentative principle, passing from one person to ano- 
ther, has never been given. The local cause exists in 
the neighbourhood of the epidemic. All matters, capa- 
ble of producing the peculiar local effluvia, may increase 
its strength and hurtful tendency. The perspiration 
and other excrementitious matter of the sick may be, 
and probably are of this kind ; and therefore ought to 
be neutralized, or removed, er interred. 



CHAPTER IX. 



ANGINA EPIDEMICA, OR CANKER-RASH. 



" Quod ei certe non confitendum modo fuisset, verum etiam 
prodicandum," Cicero- 



SECTION I. 

Preliminary Observations. 

The vulgar name is preferred to angina maligna, cy- 
nanehe typhoides, scarlatina anginosa, &e. All names, 
in any manner descriptive of the type of epidemic dis- 
eases, ought to be discarded ; for the predisponent 
causes and state of the system are so variable, that no 
name can suit them, nor can it apply, in the manner ob- 
servable, in the invariable affinities in cliy mical combina- 
tions. 

Perhaps in no disease, has false theory been produc- 
tive of greater mischief than in this. As the disease 
has invaded this country at uncertain intervals of about 
seven or eleven years ; the younger part of the profes- 
sion are obliged to have recourse to books chiefly for 
information. In looking into those of the highest autho- 
rity, they find but little better than confusion and uncer- 
tainty. With a view of establishing the favourite theory 



SECT. I. ANGIXA EPIDEMICA. 33S 

of specific contagion, the advocates of this have had to 
divide the disease under consideration into two or three 
distinct diseases ; and have been forced to assign as 
many kinds of specific contagions, for the purpose of 
supporting their theory. Laboured attempts have been 
made to prove, that angina maligna and scarlatina an- 
ginosa depended on contagion for their propagation, 
possessing a specific difference. These authorities are 
so generally known, that it is unnecessary to refer to 
them ; if we should, it would be necessary to refer to 
almost every treatise on the subject, that is extant. 

By all these imitators of great men's errours, it is, 
notwithstanding, acknowledged, and the fact is undenia- 
ble, that when cynanche maligna prevails, some cases 
appear ofless severity, and are, therefore, called scarla- 
tina anginosa. And again, when the latter rages in any 
place, many eases appear of greater severity, and must, 
therefore, be called cynanche maligna. And in conse- 
quence of this, a different contagion must be assigned, 
and the patient must submit to a very different regimen, 
although the disease may be the same, only differing in 
degree. 

It is acknowledged, that both diseases arc attended 
with soreness and ulceration in the throat, and that both 
are attended with eruptions, and often in the sequel with 
adipose swellings. And it may here be remarked, that 
there is no more propriety in dividing this disease into 
two kinds, than there is of dividing any other epidemic. 
It is always the fact, when any epidemic prevails, some 
cases are more mild and others more severe. The severe 
cases have been called malignant, and this has become 
synonymous with putrid ; it is hoped the use of the word 
Hta.viv will correct this errotir. 



33* ANGINA EPIDEMICA. CHAP. IX. 

It may further be observed, that when epidemics of 
the same general character prevail, in different periods, 
they do not assume the same degree of violence ; some 
epidemic periods afford a much greater proportion of 
severe cases than others. This is conformable to the 
observation of all practitioners in other epidemics, such 
as epidemic pleurisy, dysentery, and even influenza. On- 
ly apply the same analogy to epidemic angina, and the 
mystery is solved. The same parallel facts are noticed 
in the acknowledged contagious diseases, such as small 
pox and measles. At some periods, there will appear a 
^reat proportion of severe eases, called the confluent 
small-pox. When the measles prevail at certain peri- 
ods, giving a strong pestilential diathesis in the atmos- 
phere, many severe cases will appear, called by some 
anomalous, or malignant, or black measles, &c. Any 
one, that is not already satisfied of the unity of the hurt- 
ful principle in angina epidemica, is at liberty to observe 
and think for himself. 

In Chap. in. Sect. 2, a short attempt was made to 
show that none of the varieties of angina epidemica were 
communicable from one person to another; or in other 
words, were not contagious. If any thing further needs 
be observed, it might be urged, that the extreme un- 
certainty of the time of the eruption might be men- 
tioned; in some cases, appearing in the first hours of 
the attack, at other times, not until the fifth or seventh 
day. Also the great diversity of the appearance of the 
eruption. In this, it shows an analogy to spotted fever. 
Also the analogy to this is observable in the circum- 
stance, that the eruption gives no relief to the pain, 
fever, or danger of the disease. This is very different 



SECT. I. ANGINA EPIDEMICA. 5S5 

in all diseases from provcable contagion. Again, many 
cases of severe angina epidemiea appear without any 
eruption, when the fever and inflammation in the fauces 
are exquisite. In this also, the analogy is greater to 
spotted fever, and other acknowledged noncontagious 
epidemics, than to diseases of specific contagion. 

This disease sometimes appears sporadically. I have 
witnessed some solitary cases in the midst of the preva- 
lence of other epidemic diseases. An instance is men- 
tioned in Chap. n. under the year 1810, by Dr. Powel ; 
again in 181*, by Dr. Allen. 

To this may be added, that no series of facts have 
ever come to my knowledge from any writer, sufficient 
to prove satisfactorily, that the disease is communicable: 
it seems, that this has been taken for granted in this dis- 
ease, as it was by many in this place of the spotted fever, 
in the season of its first appearance. It was with great 
difficulty, that the generality of mankind could be pre- 
vailed upon to believe, that it was not catching, as the 
phrase was. I am well informed, that at Wareham in 
Massachusetts, a man who was said to have died of spotted 
fever, was immediately interred in a tarred sheet, and 
without the customary rituals. He was sick only about 12 
hours, and was thought to be mortified before he died ! 
Also at Deerfield, in New Hampshire, an unfortunate 
neighbourhood were attacked with this disease in Sept, 
1807, eight of whom died. The belief of its contagious- 
ness was so great, that the people " were afraid to lend 
their friendly assistance in sickness and burying the 
dead, which the laws of nature and gratitude demanded. 
The husband, with his heart swollen with grief, was put 
to the paiuful necessity of assisting in laying out his own 



S36 ANUINA EPIDEMICA. CHAP. 1X # 

wife, for interment. Clergymen refused their assis- 
tance, &c. They chiefly died in about twelve hours, and 
were supposed " to be mortified.'" Walpole Observer. 

Were it not for one circumstance, the spotted fever 
might now have been considered contagious; which was 
its progressiveness. Although the first cases in other 
places, at its first appearance, were pretty severe, yet 
they were but few in number. If (he disease had become 
extensive, in 1807, as it was in 1811, it would even now 
have been considered, by a great proportion of people, 
as contagious $ more especially if a few influential men 
?,t a distance had sanctioned the idea. But we have 
digressed beyond our limits. 

This disease has prevailed twice, as an epidemic under 
my immediate inspection ; and each time, it was about 
two years in passing through the neighbourhood. Some- 
times a little abated, and again more frequent. The 
first knowledge I had of it, was in the year 1795. It 
was progressive in violence, and in the frequency of 
attacks. It raged in its greatest severity in the winter 
of 1795 — 6, at Bethel, where I then practised, about 
fifteen miles from this place. But from communica- 
tions from two correspondents it appears, that it raged 
about forty or fifty miles south of that place, in this 
state, in 1793, and 1794. These were the years it pre- 
vailed in « Massachusetts, Connecticut, New York, Pen- 
sylvania, &e." Webster. It again became epidemic in 
this place in 1803, and 180i. In both these periods the 
disease appeared to be governed by ihe common laws of 
other epidemics. Great variety prevailed in the severi- 
ty of the disease : the same difference as we discover in 
other diseases : some were but slightly affected, compar- 
er 



SE«T. I. ANGINA EFIDEMICA. 537 

cd to other cases. It was, in common, a severe disease, 
and a great many of the youth in the country fell vic- 
tims to it. Cases, which writers have called scarlatina 
anginosa, and also cases of what they have called angina 
maligna, could be readily distinguished. The mildest 
cases could he transformed, by wrong management, into 
the severest, accompanied with the symptoms of angina 
maligna ; and in many instances, if I am not greatly 
deceived, the severest cases were transformed into tiie 
more manageable form, called scarlatina anginosa. 

It may be worth while to attend for a moment to the 
further analogy, that seems to exist between this epi- 
demic and spotted fever. They both rage with their 
greatest violence in the winter season; they most com- 
monly affect children and young people; they are both 
severe diseases, and the period of their termination near- 
ly alike ; one diagnostic symptom is common to both 
diseases, which is a pain in the forehead under the fron- 
tal suture. Pet haps this cannot strictly be considered a 
diagnostic symptom, it being common to both diseases; 
and on account of its being sometimes absent ; but it 
very commonly attends both. Many other analogies 
might be noticed, but we shall dwell no longer on this, 
it being our more important design to notice the great 
analogies of all elementary fevers. 

Does not the circumstance of the sympathetic nerve, 
supplying in part the organs of the throat, incline the 
membranous affection there to partake, more or less, of 
the ataxic character? 

43 



33S ANGINA &HDEMICA. CHAP. IX. 

SECTION II. 

Symptoms. 

It is now necessary to take a more particular re- 
view of the symptoms of this disease. Our notice of 
these will be short, as they are fully detailed by many 
writers. 

It attacks people of all ages, but is most common, and 
most distressing in small children. Those at the breast 
are not so liable to this, nor any other epidemic, as they 
are when one or two years old. The younger the sub- 
jects are, when attacked, the greater the danger ; partly 
from the aptitude in young subjects to sudden and high 
responding febrile commotion, and partly from the ina- 
bility to cleanse the throat. It is most likely to attack, 
like all epidemics, those possessed of the most irritable 
fibres. The disease is excited by the common exciting 
causes of other fevers. 

The symptoms at the attack are in common with 
other fevers, lassitude, drowsiness, cold chills, followed 
by heat, pain, &e. The distinguishing characteristic 
of this disease is that the local inflammation falls upon 
the fauces or internal throat. From this, most com- 
monly, proceeds a reflective or sympathetic eruption, 
extending progressively from the throat over the whole 
body, which is often of a scarlet or crimson redness. 
The eruption usually appears on the second or third 
day, but is subject to much irregularity. In some of the 
most severe cases, it does not appear at any period, but 
most commonly attends. It may pass away in a few 
days, and takes with it after some longer time the cuti 



•SOT. II. ANGINA EPIDEMICA. 659 

cle, either in a branny form, or after some length of 
time, where it is very thick, in large flakes. 

Tiie inflammation extends more or less from the fau- 
ces into the adjacent muscles and glands, appearing ex- 
tern . 1 1 v with soreness and enlargement. In some cases 
the swelling externally is very considerable, and rarely 
ends in suppuration. 

The inflammation spreads to the internal membrane 
of the nates, and also to the membranes of the brain, 
where it is attended with different degrees of violence, 
and marks in a principal manner the danger of the dis- 
ease ; producing various symptoms in common to ery- 
thematic inflammation of the membranes of the brain. 

It sometimes follows the eustachian tube to the inter- 
nal ear, producing deafness, with a discharge of puru- 
lent sanies. 

The inflammation, as in other epidemic affections, 
spreads along the course of similar texture through the 
larynx, trachea, and lungs, with different degrees of 
violence ; sometimes producing croup, and sometimes, 
though rarely, pneumonia. It often extends along the 
whole tract of the alimentary canal, and appears in the 
anus by excoriations ; producing in the stomach nausea, 
and in the intestines diarrhoea. Some have imagined, 
that this affection of the primse vise was from swal- 
lowing the effused matter of the throat, but facts and 
analogy teach differently. 

The progress of the disease depends wholly on the 
state of the fever. The inflammation of the fauces is 
altogether in conformity to the violence of general dis- 
eased action. Various symptoms are discoverable in 
the system, as depending upon different degrees of fe- 



3*0 ANCINA EPIDEMICA. CHAP. JX. 

brile violence, which are uot importaut to mention indi- 
vidually. 

Some further attention should be given to the inflam- 
mation of the fauces. The soreness and pain here are 
synchronous with the first symptoms of fever ; and if I 
am not mistaken, I have noticed often the affection of 
the throat, as the first ostensible symptom. If so, I 
have no inclination to consider this a local disease, any 
more than dysentery \ but a general disease, whose loca- 
lity is in the throat. 

The fauces at first look red, slightly affected with 
swelling, not of the phlegmonic kind, but a thickening 
of the membranes ; the tonsils appear enlarged, but do 
not suppurate. Within twenty-four hours, the mem- 
brane of the fauces discharges viscid matter or tough 
phlegm; exhibiting, at the same time, specks of an ash 
colour, which slough off, and show an ulcerated surface, 
discharging various conditioned matter. This marks 
the milder or more manageable form of disease, which, 
however, often proves fatal, under the treatment com- 
mouly recommended for eynanehe maligna. 

If the prostration of strength is great, and the system 
labours under an oppressed circulation, with a quick 
pulse, and but little activity in minute vessels, being the 
highest grade of diseased impression ; in this condition, 
the colour of the inflammation is of a deeper red, and 
the spots of canker of a brown colour, and in a short 
time* the fauces appear covered with a dark coloured 
exudation, which casts off, followed by a sanious dis- 
charge. In this case, the countenance is commonly pale 
and dejected, &c* The same ichorous matter is some- 
times discharged from the tonsillary, faucial and nasal 
inembranes, aud may continue for weeks in some cases* 



SECT. 111. ANGINA EFIDEM1CA. 3*i 

In 1803, 1 saw a case of this kind of four weeks conti- 
nuance in a child, who had not proper attention, where 
worms were discharged from the nostrils. 

The pulse is generally very quick, from an hundred to 
an liuudred and forty, often small, irregular and oppres- 
sed ; and often hard, with considerable fulness ; subject 
however to all the variations incidental to the varied 
states of general oppressed action. 

The heat on the surface is often very intense ; but in 
a considerable number of cases, it is moderate. The 
adnata of lhe eve is streaked with blood. 

The period of termination of this disease is uncertain, 
like all oilier epidemic diseases. It terminates fatally 
sometimes in twenty-four or forty-eight hours, most 
commonly on the fifth day, and, in protracted cases, not 
until three weeks. 

The disease is often followed in about three or sis 
weeks with an universal congestion, or bloating of the 
eellular texture of the body, not of limped water, but 
viseid mucus ; so tenacious, that it does not fall to the 
depending parts of the body. 

SECTION III. 

Treatment. 

Whilst it is the opinion of some, that these two vari- 
eties of angina are specifically different, they are led to 
presume, that the treatment must be very different. 
Undoubtedly the treatment admits of some variety, as it 
will in all epidemics of the same general character; but 
still, we ought to have the great leading objects in view, 
in the treatment, that we have in all other elementary 



342 ANGINA EPIDEMICA. CHAP. IX. 

diseases, and in all other diseases, conneeted with fe- 
brile commotion. Strict regard should be had to the 
identical state of diseased action, to be ascertained and 
measured by the judgment of the physician whilst exa- 
mining the case. If an opinion should be grounded on 
the presumption, that the disease is of the typhoid cha- 
racter, and that the reigning epidemic is malignant or 
putrid, in all cases, he may be greatly liable to be de- 
ceived, if not in the diagnosis, yet he will be in the treat- 
ment. For custom seems to have fixed an indissoluble 
conneetion between typhoid and the treatment of high 
stimulation. The dread of all evacuations is connected 
by an unbroken association, and whoever dares trans- 
gress the ancient oracles must be adjudged guilty of 
mal-practiee. 

All that has been advanced in the previous chapters 
relative to the oppressed state of the system, and the 
condition of dormant action in the minutest vessels, will 
apply here in its extent. The greatest danger is to be 
apprehended in those cases, where the febrile action is 
not capable of being diffused through the system ; when 
there is no capability of producing such a degree of 
vigorous action on the surface and minute vessels,^as to 
restore equality of action to the torpid vessels. In this 
case, paleness appears in the skin, the eyes are sunk, 
and the countenance fallen. Action languishes in the 
fauces, and these are covered with a darkened exuda- 
tion. Small quick pulse. Again, 

Nearly alike dangerous are those cases, in which fe- 
brile action is very vehement ; attended with much red- 
ness on the skin, severe pain in the throat and head, de- 
lirium, &c. These cases are more manageable in this 
disease, as we find the same state of disease to be in all 



. HI. ANGINA EPIDEMICA. 

epidemics. In this MM Uie in ieation is simply to mode- 
rate effectually the violence of febrile action to a stale 
of medioci -icy. 

In the h\ st mentioned state of the system, the indica- 
tion is two-fold. First : to emancipate the system from 
the over-controlling pouer of primary diseased impres- 
sions, and give it au opportunity to respond in universal 
febrile action; and, secondly, to moderate this to the 
degree of safety. It will be difficult to separate these 
indications wholly in the treatment : they must progress 
in a measure at the same time, and be varied, as the 
particular case may require. As we see diseases, par- 
taking of all varieties of severity, so remedies should be 
applied according to the degree of violence. 

In the second state of the system, mentioned above, 
the febrile commotion is the greatest, when at the same 
time, it is manifest, that the immediate and primary 
diseased impression is not so great, as that in the first 
state proposed. In the first state proposed, the sedative 
cause is so great, that the energy of the system retires 
before it, and energy begins first to fail in the most re- 
mote parts of the system, and suddenly fails in the more 
noble organs, if not relieved. 

Perhaps these propositions, may, in part, at least be 
assented to: but the manner of obtaining the desired 
relief, is most likely to produce a diversity of opinion. 
Bat little argument can be admitted here. Reference 
may be had to Chap. v. for a more particular illustra- 
tion of principles, relative to the cure of fever. And in 
this place a short statement must suffice ; and as relat 
ing chiefly to the peculiarities of the present disease. 

When the first mentioned state of the system appears. 
being that which has been styled cynanche maligna, wc 



o±± ANGINA EPIDEMICA. CHAP. IX. 

are ready to declare, from repeated experience, that 
the treatment heretofore proposed by the most eminent 
writers, is not adequate to the removal of the disease in 
its most dangerous form. We will not undertake to 
say, that any management whatever, will always piove 
fortunate, especially, when practised at large. But this 
rests as a matter of opinion, founded on facts, that, a 
much greater number have, and may be restored, by a 
different process. 

The writer feels compassion for any young practi- 
tioner, placed in the condition he was in during the 
winter of 1795 — 6*. Not having met the disease be- 
fore, and knowing nothing of it, but what was to be 
found in books and the current practice, the disease often 
proved fatal under his own management, and also under 
that of others. Many fell before it, whilst the tonie 
and stimulant plan were diligently and indiscriminately 
pursued. Chagrin was a very constant and unwelcome 
companion. It is hoped forgiveness will be granted for 
errours unwittingly committed. The determination was 
formed to abandon the practice of medicine. It was, at 
length, determined to abandon every author, and the 
advice of every friend, and be guided wholly by physiolo- 
gical principles, checked by observation and facts. 

Delivered from imposing mandates, the character of 
the disease was studied with diligence, and the effects of 
every remedy carefully noticed. The disease was called 
the ulcerous sore throat; blood-letting was forbidden. 
My opinion was, that some cases, at least, required it. 
I put it in practice in those cases partaking more espe- 
cially of the second state of disease, above described, and 
which has a greater resemblance to those heretofore 



SECT. HI. ANGINA EPIDEMICA. 345 

called scarlatina anginosa. The relief it gave warranted 
its repetition, and in a short time, it was practised to the 
same extent as in other fevers. Success followed in the 
same ratio, that disappointment had before. It soon 
became my common practice to take three or four full 
bleedings, in the like cases, that before were thought 
not suitable to bear one. The event was, that almost 
every patient treated in this manner, and along with 
antiphlogistic measures, recovered. At the same time, 
cathartics were employed ; these were chosen of such 
as could be given in a watery solution, on account of 
their being more readily swallowed, and as they could 
receive very readily some portion of purging neutral 
salts, such as sulphate of soda, vitriolated tartar, cream 
of tartar, &c. Almost all stimulants and tonics were 
discarded; and in those cases, attended with inflamma- 
tory eruptions, the patient was at liberty to choose his 
own temperature of warmth, meaning that which might 
be most agreeable. 

In many cases, the swelling of the fauces, tongue and 
adjacent parts was very considerable, and the pain of 
these parts very severe. Great relief was gained by 
puncturing the ranular veins under the tongue, giving 
vent to a small portion of blood. This may be often 
repeated. 

As it was of some importance to keep the throat free 
from tough phlegm, gargles were used of sulphuric or 
of muriatic acid in water, as strong as the patient might 
be willing to use them. Also common salt dissolved in 
vinegar, and a little diluted was useful, taken warm. 

In cases destitute of eruption, or in those having a 
darkened colour, bathing the feet, legs, and arms, and 

44 



3&6 ANGINA EPIDEMICA CHAP. IX. 

even the whole body, in warm water was often very 
agreeable and salutary. 

The eruption was sometimes attended with a sensation 
of extreme heat; but it seldom became necessary to 
lower the heat by external means; bleeding and purging 
would commonly soon reduce it sufficiently. In a few 
cases, however, cold water applied by affusion answered 
a good purpose. In the summer of 1803, I met a case 
in Hartland, if I mistake not, on the ninth day of the 
disease, in which the eruption at that time, was attended 
with a high degree of inflammation ; a crimson eruption 
and elevation of the cuticle; the pulse very rapid and 
hard. 1 1 was a girl of about twelve years ; she had been 
bled sparingly several days before : it appeared that she 
could not have lived many hours in her situation; dis- 
tress was exquiske; partial delirium with partial insen- 
sibility. I bled her about a wine quart ; she was then 
rolled in linen sheets, wet with cold water, and this 
sprinkled upon her for about eight hours, when the bed 
was drenched with it. She immediately showed signs of 
amendment, and suddenly recovered without any other 
treatment worth mentioning. If aspersion of cold water 
had been practised early in this case, and without bleed- 
ing, it would probably have been hurtful. 

Cases are introduced only to illustrate principles, and 
not to serve as precedents without the most scrupulous 
regard to every collateral circumstance. No invariable 
practice can ever be pursued in epidemic diseases; the 
particular circumstances of each case must determine 
the measures to be pursued. Whilst cold water is emi- 
nently useful in certain cases, immersion in warm water 
is not less so, in other cases. 



SECT. III. ANOINA EPIDEMICA. 347 

We have now beeu speaking of (he more obvious and 
manageable cases of angina epidemiea. The more intri- 
cate part of the subject is before us in the treatment of 
the first state of the system described above, and which 
has been denominated angina maligna. This is only an 
higher grade of the diseased affection ; so manifestly do 
the hurtful powers appear, that sudden oppression is dis- 
covered in every organ in the system. The circulatory- 
system is deficient in ability to perform its accustomed 
round, and deficiency of action is apparent even in the 
heart. This organ performs its office not in the accus- 
tomed manner, but impetuously, and as it were strug- 
gling for existence. The impediments must be removed. 
The important question is, what will do it ? If it cannot 
he declared what will do it, it can easily be declared 
what will not do it. Opium and brandy, tonics and other 
stimulants internally, will not do it ! Not only correct 
theory, but experience abundantly proves this, when ex- 
hibited in the common manner. In speaking of stimu- 
lants internally, we wish to be understood in a limited 
manner ; certain medicaments undoubtedly possessing a 
a stimulant power, are proper internally, but they must 
be those, that have a peculiar property of producing 
more action and warmth in minute vessels, than they 
have upon the larger sanguiferous vessels. It may be 
queried whether such medicines really exist ; if so, it 
will be suggested that ether may be one of these ; also 
that cayenne, seneca, and aromatic essences, may be 
others ; and many perhaps beside these. For example, 
one fourth of a wine glass of common spirit,with a gill of 
hot water, will produce a more sudden and more effectual 
glow of warmth in the body, than a full wine glass of 



345 ANGINA EFIDEMICA. GHAF. IX. 

spirit, without the hot water. Double advantage is ob- 
tained whilst using these diffusible and transient stimuli, 
it' moderate external warmth is steadily persisted in. It 
should, however, be remarked, that on aecount of the 
cuticular inflammation connected with most cases, that 
much heat is seldom proper. 

But the cure of this formidable state of disease is not 
to be trusted to internal stimulants ; indeed only in a small 
degree ; all the facts and arguments in Chap. v. will 
apply here. The patient should be immersed in warm 
water, or water with common salt dissolved in it ; or a 
bath of the infusion of aromatic herbs. In these eases, 
warmth should be steadily applied, and action not suffer- 
ed to languish for the want of their use, until a more 
permanent and natural action is established. The tepid 
bath may, therefore, need to be often repeated. Fric- 
tions should be used connected with warmth. In these 
cases, the eruption is either wanting, or of an aspect 
which proves a high degree of torpor on the surface ; 
action must be restored on the surface, and then it is 
altogether immaterial whether the eruption appears or 
not. A very vivid eruption denotes, sometimes, a very 
severe ease ; and a small eruption often attends a mild 
case. It is not so much, therefore, whether there be an 
eruption, as whether the function of the minute vessels 
be well performed ; or whether the exercise of vitality 
be well performed in the minute vessels. 

We will lay aside matters of opinion, and declare it as 
a matter of fact, that blood-letting, prudently adminis- 
tered, has the effect oftentimes of removing cold chills, 
and restoring equal and durable warmth in the case of 
epidemic angina. The manner, then, that we have 



SECT. III. AJSTGINA EPIDEMICA. **• 

usually proceeded in these formidable and perplexing 
cases is, to immerse the patient frequently in a tepid 
warm bath. In the intervals to apply a moderate warmth. 
Give agreeable warm drinks internally, impregnated of- 
teutimes with some agreeable aromatic tincture, or es- 
sence ; or an infusion of seneca, or cayenne.* These 
two last are most effectual to excite action in the absor- 
bent system or minute vessels generally, as well as in the 
throat. Lose no time after the bath, in taking a small 
bleeding ; or according to the appearance of the patient, 
perhaps a common bleeding, if it is borne well. Let the 
patient rest in a moderately warm bed. Give small doses 
of calomel, castor oil, honey, and cayenne, combined in 
the form of a linctus every hour, or half hour, so that a 
gentle cathartic operation shall be effected in about six 
or eight hours; then omit it. Apply the steam of vine- 
gar and hot water very moderately by Mudge's inhaler, or 
a tea pot with the lid raised, so that a mild steam will be 
inhaled by the patient. Whilst these measures are in 
operation for only a short time, the pulse may commonly 
be observed to change from the greatest frequency and 
smallness, to more fulness and constancy; distress miti- 
gated. The external heat should not be so intense to the 
surface, as in cases of spotted fever and dysentery, but it 
should be steadily persisted in. Blisters on the neck 
and arms. Sinapisms to the feet. These suggestions 

* A method of preparing this, as recommended by Dr. Tho- 
mas, may be worth trial. Take of cayenne pepper, two table 
spoonfuls ; one tea spoonful of common salt; half a pint of 
boiling water; half a pint of warm vinegar. Strain through 
a fine cloth. Dose, two table spoonfuls every half hour, for 
an adult. 



3JU AKdUU BPIDBMICA* CHAP. IX. 

4 

arc meaut to apply to the first attack, within a few hours. 
If the state of the system is changed, in any manner 
from the ordinary condition at the attack, the remedies 
should be varied according to the particular case, by the 
judgment of the physician. Also the quantities may be 
varied according to circumstances. 

By a steady perseverance in these, or similar mea- 
sures, the torpid action of the surface, and vacillating 
action of the sanguiferous system, will most commonly 
be changed to a more steady, equable, and fixed febrile 
action, called inflammatory or sthenic ; and in this con- 
dition approximating to the second state of the system 
described, usually called scarlatina anginosa. When in 
this state, the disease may commonly be managed ; if the 
physician is possessed of boldness and perseverance to 
adopt remedies to suit the degree of morbid excitement, 
and is not dilatory, on account of trusting too much to 
the precarious operations of nature. 

By way of illustration, a single case only will be relat- 
ed. In March, 1803, H. A. in her ninth year, an only 
daughter, the delight of her mother, and the fond expec- 
tation of her father, was attacked, after fatigue, with the 
usual symptoms of severe angina epidemica. Great pros- 
tration of strength; severe pain, especially in the head; 
in a few hours, brown and dry tongue ; crimson colour in 
the fauces, with slight swelling, and an exudation, 
which at the end of forty-eight hours was of a dark 
brown. The throat so filled, that deglutition was 
greatly obstructed, and speech failed; slight delirium; 
pulse the first day one hundred and forty, and tremulous; 
no eruption. 

Warm bath the first day, being towards evening, only 






T. III. AWGINA EriDEMICA. o5i 

once, for fifteen minutes; kept warm through the night. 
Bled after the bath about eight ounces. Cathartic imme- 
diately followed by senna, rhubarb, and sal glauberi. 
The common gargles used ; but little phlegm evacuated. 
Frictions moderately and frequently repeated. 

The second day bled twice, and immersed in warm 
bath of water and common salt, three times ; kept in the 
bath about fifteen minutes each time,* every time gave 
some ease, as also did the bleedings. Pulse more pro- 
mising at the end of thirty-six hours. Frictions conti- 
nued. 

Third day, state of the fever more promising, but still 
severe ; no eruption ; slight delirium ; throat black ; 
impossible to breathe through the nostrils; she had not 
spoken for some hours, and scarcely possible to swallow 
the smallest liquid. But slight swelling externally. 
Phlegm and sordes in the throat, so dry and tenacious 
as not to be removed by gargles. My wish was to get 
down an emetic to clear the throat. After repeated tri- 
als, enough of a strong solution of tartarized antimony 
was taken to effect an operation, at the commencement 
of the fourth day. The first operation so far removed 
the congested matter in the throat, that she was ena- 
bled to exclaim, " now, papa, I shall get well, for I can 
speak." Her recovery was most astonishingly rapid ; for, 
by the seventh day, she was able to ride a mile in a 
sleigh. A considerable number in the neighbourhood 
had the disease at the same time, generally with erup- 
tions. Nothing more stimulant was taken in this case, 
than a very little spirit of lavender and common tea 
drinks. 

The advocates of the mercurializing and stimulating 



352 ANGINA EriDEMTCA. CHAP IX. 

method of cure, may enjoy the pleasure of boasting of 
their catholicons, if I can possess the satisfaction of see- 
ing such cases as this restored by more humble means. 
I feel to speak with submission, when I say, that it was 
rare for a case to go wrong under similar management, 
and common opportunity; if practised before the stimu- 
lant plan had been used; notwithstanding the adverse 
circumstances attending cases at large. 

A few general observations will close this section. The 
more strictly sthenic cases, when properly treated, ter- 
minate in health in a short time; if not properly treat- 
ed, when yet the patient survives the first stage, and 
continues diseased, he is to be treated upon the same 
general plan, having respect to the particular circum- 
stances of the case. A very mild course of antiphlogis- 
tic measures, with moderate perspiration, being all that 
is usually necessary. Patients seldom bear high stimu- 
lants in any stage of this disease. 

If the case partakes more of the character of angina 
maligna, so colled, and the disease is not arrested, when 
yet the patient survives the first stage, the case is wont 
to degenerate into a chronic fever with a discharge of 
ichorous matter from the fauces and nares, called cory- 
za. This condition of disease is often very perplexing. 
A very frequent small pulse ; great debility ; often slight 
delirium ; ulceration in the membranes of the fauces, 
even extending into the remotest passages in the nasal 
cavities ; perhaps along the eustachean tube ; also the 
lungs, stomach, and intestines. Where the cuticle is in 
any manner injured, as by blisters, scratches, &c. slight 
ulcerations follow of a phagadenic kind, commonly 
known by the name of canker. It frequently proves 



iJSCT. IV. AICGINA EPIDEMICA. 35S 

fatal in about three weeks. This is a protracted case of 
the epidemic, occurring most commonly from neglectful 
or from bad treatment. 

The remedies, which I have thought most useful, are, 
mild nutritious food in a potable form ; milk; weak de- 
coction of Peruvian bark, and elixir of vitriol ; sublimed 
sulphur and cream of tartar, made into an electuary with 
molasses, and given in small doses, so as to prove mode- 
rately cathartic, and often repeated; solution of borax; 
Wfak solution of soda ; sweet spirit of nitre ; gargles of 
vegetable and mineral astringents, such as marsh rose- 
mary and alum. Use a general tepid bath twice a day, of 
malt boiled in water. In every case where I have seen 
calomel and opium used, they appeared to do harm, 

SECTION IV. 

Sequel of angina epidemica. 

What is called by writers the anasarcous swelling, 
following this disease, is spoken of as of little conse- 
quence, by those I have seen. It has, in various instan- 
ces, appeared to be a very treacherous and formidable 
disease. The first case I met with in 1795, was suddenly 
fatal. A boy of about six years, by the account of his 
parents, had the epidemic about three weeks before, ra- 
ther slightly ; showed but small signs of disease after- 
wards, until a short time before I saw him, and then 
nothing to greatly alarm the family. The day previous 
to my seeing him, which was in the evening, he showed 
more signs of indisposition ; appeared drowsy, and com- 
plained of pain ; there was a fulness over his body, as 
much in his face as in his feet ; a shortness of breath, 

45 



£54 ANGINA EPIDfiMICA. CHAP. IX. 

&c. His pulse was most astonishingly quick, small and 
tremulous ; it could scarcely be counted. The family 
were surprised when they were told, although the case 
was new to me, that it was my opinion, he could not 
continue but a few hours. He died that night. He 
took a portion only of common physic. 

Since that time, I have met with a great number of 
these cases. Many have proved fatal in this part of the 
country, between three and six weeks after the first at- 
tack. The ostensible symptoms are not in proportion to 
the degree of danger. It has been my practice to attend 
diligently to these cases, when they happen within my 
notice. I consider them as the original affection, only 
partially cured ; producing an effusion of gelatinous 
fluid in the cellular texture universally, as v/ell internal- 
ly as externally. 

If the case is a mild one, perhaps drastic physic, seve- 
ral times repeated, would be sufficient to remove the 
fever and depositions in the cellular membranes. If the 
case is more severe, it becomes really necessary to take 
blood, notwithstanding the smallness of the pulse, and 
notwithstanding any suggestions to the contrary, from 
apparent debility. I have bled several times in the same 
patient, and used active cathartics, as jalap and calomel 
every second day, and on the intermediate day a full dose 
of tartar emetic, so as to effect four or five emetic ope- 
rations, and produce some sweat. This method should 
be repeated until the pulse is rendered less frequent, and 
the bloating dissipated. 

Instead of debility being increased by this method, the 
patient grows stronger, and in a short time is restored to 
health. I have never known it fail to be effectual in any 
oase where it has been used sufficiently, even in the most 



SECT. I>. ANGINA EPIDEMICA. 3b6 

dangerous states of the complaint. At the same time, I 
lme known a \ery considerable number of cases, where 
it was supposed the smallness of the pulse and apparent 
debility forbade bleeding, proving fatal, whilst the tonic 
and stimulant practice was diligently pursued. 

In ISO*, I met a case in Bridgewater of the most seri- 
ous aspeet, in a boy of about eight years, who had been 
treated with tonics and stimulants, until his life was des- 
paired of; with a pulse hardly distinguishable. With 
much persuasion, it was at length agreed upon to try 
bleeding, &c. The event was fortunate, for he was 
shortly cured by pursuing the above method. 

One further fact may be worth relating. I have never 
known this state of disease occur where the evaeuant 
and excitant method of cure was properly used, and the 
force of the primary disease averted in the first stages. 
But when it happens, it has always followed, either those 
cases treated without evacuations, or those which hap- 
pened to be so mild, as seemed not to require much 
treatment. 



CHAPTER X. 



TYPHUS EFIDEMICUS, OR SLOW FEVER, OR CONTINUES 
FEVER. 



" Fact shall be opposed lo fact, cause to cause, and argument U 
argument." Twlly. 

SECTION I. 

Preliminary observations. 

The word typhus is derived from the Greek tuphos. It 
is the same disease which by some is called slow, or long 
fever, or nervous fever. It is used to express the character 
of a genus in nosology, including those levers, which show 
more especially a nervous affection, in opposition to those 
which show more eminently a sthenic or inflammatory 
action, called synocha. As if the character of fever was 
to be designated, like the declensions in grammar, by the 
terminations of words ; a fever supposed to be compound- 
ed of these two is called synochus, or mixed, or rather 
mongrel fever. 

These divisions might be well enough to show, that 
some epidemics are more rapid in their symptoms and 
progress than others $ and also to designate degrees of 
yiolence in individual cases, were it not, that influence 



SECT, la TYPHUS FEVEK. ;i5? 

and custom have too much fixed an indissoluble connec- 
tion between generic names and the treatment. The inju- 
ry is conspicuous in this ; let the name of fever be deter- 
mined on, and the student will look into books and find 
the treatment ; and this may, or may not suit the case. 
The symptoms of all fevers are more or less mutable, 
and the young inquirer will be at great loss, perhaps, to 
determine,whether it is real typhus or not, from the symp- 
toms in the varying stages of the disease. Indeed an old 
physician will often need as many eyes as Argus had, to 
discover which genus his particular case should be plac- 
ed in. Almost every book contains a long catalogue of 
symptoms of disparity in typhus or slow fever. Even 
Air. Wilson asserts, that " there are few complaints, in 
which the symptoms are more varied, than in typhus, 
whether we regard its accession or its progress." It is 
asserted, that sometimes " its access is so mild, that for 
several days, the patient is not sufficiently indisposed to 
be confined to his bed ;" at other times, " on the first 
attack of typhus, falling suddenly to the ground, as if 
thunderstruck." At one time, it is said, the heat of the 
body is not increased ; at another, it is said, the heat is 
so great, that it is painful to rest the hand upon the sick. 
Again, at one time, the patient lies comatose; at ano- 
ther, he is afflicted with a raving delirium. 

For the purpose of accommodating the geometrical 
rules of nosology, typhus has been divided into graviov 
and mitior. This only denotes the extremes ; and cases 
actually arise in the course of an epidemic season, par- 
taking of all the intermediate degrees of morbid excite- 
ment and corresponding symptoms. These observations 
are made to show, not only the folly, but the crimina- 



358 TYPHUS FEVER. CHAP. X. 

lity of nosological divisions ; they no more enlighten the 
honest inquirer after truth, than the ignis fatuus does the 
benighted traveller. 

It will be premised, thnt the hurtful principle, or 
cause of fever, whatever it may be, admits of much 
variety 5 some seasons of epidemic fevers affording a 
greater number of severe cases than others. It will again 
be assumed as a fact, that some periods afford fevers, 
showing a propensity to affect, in a special manner, cer- 
tain parts and organs of the body in preference to others. 
And again, it will be admitted, that much variety pre- 
vails in different temperaments, not only as respects sus- 
ceptibilities, but as respects responding action. These 
suggestions, when considered in connection, go far in ex- 
plaining the diversified phenomena of fevers. When 
that grade of fever most generally prevails which is call- 
led typhus mitior, many cases may be met with of a 
stronger or more formidable character, even answering 
the description of typhus gravior. When this last most 
generally prevails in any place, as for example, in the 
season of yellow fever, many cases are met with of ty- 
phus mitior. When the yellow fever prevailed at Phila- 
delphia and other places, from 1797 to 1803, this part of 
the country was visited with fevers of different degrees 
of severity, usually called typhus mitior ; some had the 
yellow tinge and black vomit. 

When the hurtful principles are severe and powerful, 
ihe responding actions, constituting the essence of fever, 
are violent, unless extreme oppression is produced; and 
so of the reverse. Another circumstance of high impor- 
tance should be kept in mind, that in the same subject, 
the nosological character varies in a very short time 5 the 



SECT. I. TYPHIS FEVER. 359 

gravior becomes mitior, and (he mitior sometimes gra- 
vior : and either of (hem assumes the mixed form, or 
becomes more strictly inflammatory. With this muta- 
bility of condition, the nosological character is lost ; and 
it can be of no more utility to designate the quantity of 
disease, or the degree of remedies, than a mute clock 
can be to tell the hour of time. Whoever, therefore, 
shapes the treatment to suit the general character of any 
particular genus of fever, will be liable to be misled. 
Mistakes are more serious to the patient than to the 
physician ; but it is doubly unfortunate, when neither arc 
capable of discerning them, and profiting thereby. 

The inferences from these and previous preliminaries 
seem to be ; 1st. That when the hurtful cause is powerful 
and principally affects the more noble organs, that condi- 
tion of fever is induced which is called typhus gravior. 
2d. When the same cause is less hurtful, but affects prin- 
cipally the same division of organs, that state of fever is 
induced, which is called typhus mitior. 3d. When simi- 
lar or dissimilar causes affect the more dense and more 
external membranes, that condition of fever prevails, 
which is called sthenic or inflammatory. 4th. As there 
is a frequent mutation of local affection, so the symptoms 
partake of great variety. 5th. As the state of disease is 
so constantly varying, but little dependence can be placed 
upon nosological characters ; they are liable to lead to 
fatal errours in practice. 6th. Notwithstanding the 
diversity of symptoms, fevers have many things in com- 
mon. 

The particular character of the genus may be mis- 
stated or misapprehended. It is difficult for me to un- 
derstand what is stated by some, that, "in synocha the 



360 TYPHUS IfKVEU. (JMAF. X. 

excitement is above, and in typhus it is below the healthy 
degree." It is true a difference is observable in the de- 
grees of excitement between the two genera, but in every 
case of typhus, morbid excitement is manifest by many 
phenomena, when frequency and hardness of the pulse 
are not very apparent. That inflammation exists in the 
membranes immediately investing the more noble organs, 
in some instances,we are fully assured by dissections, even 
to such a degree as to produce pus and sanious matter 
in the great cavities. The circulation is unequal ; in 
some parts there is a throbbing, in others a coldness. 
The pulse is sometimes slower than natural, at other 
times very frequent. Disparity of action is manifest at 
the beginning of the disease more especially ; but a state 
of febrile excitement above the healthy standard is as 
readily discovered, as in synocha, but not usually to the 
same degree. 

Typhus mitior seems not to differ from other epidemic 
fevers, otherwise than in not possessing the same degree 
of violence, and suddenly fatal tendency. The morbid 
impressions are supposed to be comparatively mild and 
progressive. The responding actions constituting the 
essence of fever are proportionally dilatory. It further 
appears, from facts and observation, that the hurtful 
causes are fixed and difficult to be removed in proportion 
as they are progressive. In no fever within my obser- 
vation, except hectic, has it appeared so difficult to ar- 
rest the progress of the disease, as in this. Notwith- 
standing, it may be here asserted, that its progress may 
be arrested, and its period greatly shortened. Perhaps 
further on this hereafter. 

Every symptom and circumstance warrant the asser 



SECT. I. TYPHUS FEVER. 361 

tion, that inflammation of the internal membranes is pre- 
sent in this habit of disease ; and dissections prove the 
same ; it is most conspicuous in the membranes of the 
head and abdominal viscera. The febrile congestions in 
the head produce the stupor, and those in the mesenteric 
vessels produce the enormous evacuations of blood by 
stool, which often happens, when the right method of 
cure is neglected. It should further be observed, that 
the internal congestions and erythema are not so distinct- 
ly located, as in some other fevers, but more diffused, 
occupying a greater extent, but with less severity ; per- 
haps in many instances, affecting the coats of the great 
arteries, not ostensibly in the form of inflammation, but 
imparting a high degree of irritability. 

To relieve the doubts of some, who still consider ty- 
phus to be contagious, it will be suggested, in addition to 
what was offered in Chap. in. that the judgment is lia- 
ble to be misled from the circumstance of the length of 
time occupied in this disease, whereby an opportunity is 
offered for the generation of local miasmatic effluvia 
around the sick. It will not be denied, but that persons, 
attending the sick, are rather more exposed than others, 
for two reasons; 1st. They are from the nature of the 
employment more exposed to exciting causes, as in Chap. 
in. 2d. As the excretions are very liable to ferment 
and aid the common local cause, so it may be presumed, 
the noxious effluvia are more concentrated in the imme- 
diate vicinity of the sick. Admitting all tiiis greater 
liability, it can hardly be said, that a greater number are 
affected with typhus, who frequent the rooms of the sick, 
than are affected under similar exposure to exciting 
causes in other conditions. It is again asserted from 

4« 



36Z TYPHUS FEVEU. CHA1\ X- 

particular observation the summer, and autumn of 1814, 
upon some very characteristic cases, that there is no 
more evidence of typhus being contagious, thau there 
is of epidemic pleurisy or spotted fever being so. 

It is very much doubted, whether affections of the 
mind invite or repel attacks in those diseases which are 
manifestly contagious ; but in elementary diseases, de- 
pending upon a state of predisposition and the influ- 
ence of exciting causes, the passions of the mind show a 
controlling influence. Dr. Barnwell, who is an English 
physician and a contagionist, reports ; « that while at 
Sheerness, on board a vessel of war, an infectious typhus 
fever spread for three months amongst the crew ; many 
were taken sick daily, especially recruits ; several died : 
but as soon as intelligence came, that they were all to be 
dismissed, the sickness immediately stopped ; none were 
attacked afterwards." Scarcely a stronger proof could 
be given, that the disease was not contagious, or what 
they call infectious. The system is again susceptible 
of the disease ; but, on account of becoming familiarized 
to the predisponent principle, those who have been affect= 
ed are not so liable to it. 



SECTION II. 

Symptoms of typhus mitior^ or continued fevsr. 

All ages and sexes are liable to this habit of disease. 
It most commonly affects those of an irritable fibre, as 
those are most readily influenced by the common exciting 
causes of fever. Its access is commonly mild and very 
progressive. The first symptoms are usually lassitude* 



SECT. II. TYPHUS FEVER. 363 

drowsiness, slight chills, slight hcadach, or pain in some 
other part. A sense of debility aud often soreness of the 
muscles. For two, three, or four days, the affected 
will commonly pursue their business, by occasionally 
resting. At length, these symptoms increase so that the 
patient is confined to bed, in which condition he inclines 
to sleep, unless pain, distress, nausea, or conversation, 
keep him awake. This symptom often changes in the 
progress of the disease into watchfulness, or delirium. 
Frequently faintness, oppression at stomach, sighing, 
despondency of mind, A sense of internal heat some- 
times manifested externally in the palms of the hands; 
but the surface and extremities incline to coldness. 
Sometimes the heat on the surface is very considerable. 
The fur upon the tongue is not very great at first, and 
the mouth is sometimes moist ; it is sometimes dry, with 
a brown list in the centre. Pulse usually from eighty to 
one hundred or one hundred and twenty in a minute, 
small and variable. Debility of muscular motion, and 
the patient clings to his bed. 

These symptoms are designed to characterize the ac- 
cess of the disease for the few first days. Many more 
might be added ; they may be found in books. I can 
discover no difference between the disease, which has 
afflicted the people of this country for twenty years past, 
and the disease described by English writers, under the 
names mentioned at the head of this chapter. A very 
considerable number of cases have happened in this and 
the adjacent towns the present season. This disease 
prevails most frequently in August and September ; but 
no month is free from it, especially the fore part of the 
cold season. 



364< TYPHUS FEVER. CHAP. X. 

To describe all the symptoms usually attending this 
disorder, would be to name almost all the symptoms of 
fever. The subsequent symptoms depend so much on 
the method of treatment, that it seems not worth while 
to enter into a detail of them. 

Jt will only be observed, that if the patient has a for- 
tunate treatment, the violence of the disease is often 
arrested ; at least it does not become more violent, and 
frequently in two weeks the disease passes off, in as mild 
and tardy manner, as it approached. But the time of its 
leaving the patient, depends on many circumstances ; 
partly upon the management, and partly upon the length 
of time which elapses between the first approach of the 
symptoms, and the commencement of the method of 
treatment, for the safest and most expeditious cure. 
From considerable attention to this subject, my con- 
clusion is something like this ; that in general, if a 
proper method of cure is adopted on the first day of the 
attack, the disease may be expected to give way in the 
course of the first week ; if not until the second day, the 
disease can seldom be eliminated from the system, until 
in the course of the second week ; and so on for the first 
four days ; as many days as are omitted commonly re- 
quiring as many weeks as days of omission ; with this 
difference, that the longer the delay, the more unma- 
nageable and also dangerous the disease becomes. 

But to return more particularly to the symptoms* If 
the disease is not arrested in its violence, and more es- 
pecially if it is aggravated by improper management, a 
formidable and alarming set of symptoms arise, partak- 
ing more especially of that grade of disease called typhus 
gravior. These symptoms are generally progressive. 



SECT. II. TYPHUS FEVER. 366 

A very quick pulse, from one hundred to one hundred 
and thirty ; black fur on the tongue ; furred teeth ; trem- 
bling of the body generally, manifested by quickness of 
speech and subsultus tendinum ; dilated pupils ; petechise 
on the skin; small ulcerations externally or gangrene; 
cold sweats; diarrhoea; discharges of blood, which most 
commonly happen by stool ; false vision; delirium, and 
a desire to be gone ; or stupor, with insensibility; hic- 
cup, &c. With these symptoms, the disease is very 
unmanageable, and commonly terminates unfortunately. 
Bleeding at the nose and by stools, should be considered 
critical, and not interrupted. If they happen before the 
disease is greatly aggravated, and are not followed by 
tonics and stimulants, the patient will commonly recover. 
The period of termination of the disease, in health or 
death, is very uncertain ; most commonly, between the 
third and fourth week. Sometimes fevers, that are said 
to be typhus, terminate the first week ; sometimes not 
until the sixteenth week. I knew a case of an old physi- 
cian and his wife, who were sick at the same time with 
typhus fever, and treated upon a moderately stimulating 
plan ; he was sick for sixteen weeks, and died ; she was 
sick twenty weeks, and got well. I have seen a great 
number of those cases, which are not of the most formi- 
dable kind at first, continued under a mild tonic and sti- 
mulant method, to eighty or an hundred days. If the 
patient recovered, it was oftentimes only partially, and 
often relapsed into some chronic illness. 



366 TYPHUS EEVEK. CHAI». X. 

SECTION III. 

Treatment. 

However much theory may be despised by some, it is 
nevertheless indispensable in the practice of physic. It 
supposes a right knowledge of a subject. It is not, 
therefore, merely " to think" but to think rightly. 
Wrong opinions, or what is the same, false theory, in 
human jurisprudence, in religion, and in medicine, have 
led the way to countless miseries. Speculative theory is 
nothing but a system of guessing. It is necessary, there- 
fore, that the first principles of any art be founded upon 
fixed data, upon immoveable bases, and well proved by 
facts and observation, which can be relied on in a time 
of perplexity and danger. It will appear obvious, that a 
good stock of correct information is of much utility in 
any science, and it is suspected that those who deny its 
utility are destitute of true knowledge, or have been de- 
ceived by false theory. A correct theory of diseases 
cannot be obtained by reading only. As the foundation 
pillars of a building are to the superstructure, so is read- 
ing to the superior acquirements of observation and dis- 
criminative judgment. A combination of all these is 
necessary to the acquirement of a correct knowledge of 
the science of medicine. 

Some having an opinion, that nature, as it is called, or 
the vis mcdicatrix naturae, must be supported and help- 
ed in all her operations, have seemed to be over careful 
to administer such means, as give energy for a time, 
in almost all febrile diseases. It seems as though such 
had forgotten, or never knew, that nature is most apt to 



SECT. III. TYPHUS 1EVEK. 367 

outdo herself, and fail from her own excessive operations. 
Instead of the use of stimuli, which affects the irritability 
of the system, and actually increases the morbid or re- 
sponding action, the primary fault should be searched 
out and removed. This being accomplished, excessive 
and morbid excitement will be lessened, the severity of 
disease removed, and health restored. 

In the instance of the disease before us, on account of 
symptoms of apparent debility, or in a more particular 
view of the subject, on account of febrile symptoms be- 
ing upon a low scale, compared with other febrile dis- 
eases, a general impression has seemed to prevail, that 
the tone of the system should be raised in some measure - 
upon an equality with the febrile action in other diseases, 
When stimulants internally are exhibited for this pur- 
pose, the system is greatly liable to suffer from the two- 
fold power of the responding force of the system, and the 
additional force of the cordial or stimulating medicines. 
The morbid impressions are strongly fixed in the usual 
course of the disease, but rather mild, compared with 
many other diseases ; the responding actions, constitut- 
ing fever, are dilatory in proportion. But this should 
always be kept in mind, that as the disease is slow in 
operation, it will be slow in its termination, and require 
as great a quantity of vitality or excitability in the sys- 
tem to carry the patient safely through it, as if the term 
of the disease were shorter. Now it must be understood, 
that vital energy is not to be preserved by a great quan- 
tity of stimuli ; but it is rather exhausted thereby. The 
truth of this remark must be apparent to every one, who 
has, in the most superficial manner, observed the lan- 
guor that follows fatigue, or debauchery, or any exces- 
sive stimulant operation in health. 



365 TTFHUS FEVER. CHAP. X. 

TIic same parity of reasoning may be applied, and with 
greater force, where the system is labouring under the 
impressions of disease, which produced stimulating effect 
upon the system. The action is above the point of medio- 
crity, or that which is natural and healthy, and cannot be 
sustained for a considerable length of time, without danger 
of exhausting the excitability of the system, and thereby 
inducing a state of indirect debility and eternal rest. The 
danger, connected with this state of disease from a slow 
and permanent cause, is as great as that from a violent 
and permanent cause ; with this difference, that one ar- 
rives at the point of exhaustion of vitality in three days, 
whilst the other does not until perhaps three weeks ; pro- 
vided the morbid derangement is not removed. 

If these introductory remarks are just, the conclusion 
follows, that those medicines, which increase arterial 
action in the system, called stimulants or excitants, are 
nearly as preposterous in fevers of a slow character, as 
in those of a more rapid progress ; and all the difference 
consists in this, that the injury in the one is not so con- 
spicuous and immediately hurtful as in the other. " Be- 
hold the end," should continue to be the motto of every 
physician. Excitability should be carefully preserved, 
and not lavished away by the use of unnecessary stimu- 
lants without answering any good purpose. These eventu- 
ally tend to bring on that state of irrecoverable debility, 
which is so much dreaded, and to prevent which, false 
theory has inculcated their exhibition. 

In diseases, having a violent access and rapid termina- 
tion, physicians have exculpated themselves, and in some 
measure justly, from the charge of ignorance, on account 
of the want of time. In the present instance, this will 



SECT. III. TYPHUS FEVER. 369 

not do, for the disease is sometimes protracted to such 
a length of time, that the reiterated visits become irk- 
some to the patient, and not void of chagrin (o the physi- 
cian. It seems advisable, that we either acknowledge 
our ignorance, or prove our skill in removing the disease 
in a reasonable time, according to the circumstances of 
the case. In a recent case, and where circumstances 
arc favourable* with honest and faithful nurses, the trial 
may fairly be made. In cases of some standing, and 
where right measures have been neglected and wrong 
measures substituted, it will be difficult to effect a remo- 
val of this disease in any given time. All that can be 
done, is to moderate the state of violence and greatest 
danger, and wait a hopeful termination. 

The first applications of remedies often determine the 
violence and duration of the disease. Nothing can be of 
greater consequence, than to measure the degree of dis- 
eased state in the beginning, and to adopt remedies to 
meet it. No writer, that I have ever seen, has given 
directions with any confidence of success, to be pursued 
in the latter stages of fever, when the action of the heart 
and arteries are failing in force and increasing in fre- 
quency, and whilst the primary cause of the disease is 
still not removed. The case cannot now be controlled, 
nor hardly regulated. If stimulants and cordials are 
given, their use, for a short time, may be flattering, the 
pulse may grow slower and more full, and the patient be 
relieved from despondency; but their effects are evanes- 
cent as the evening twilight, which soon vanishes into 
perfect darkness. After a few repetitions, vitality fails 
no more to be restored. If depletion is practised at 
this time, nothing is gained, for the system has suffered 

4,7 



370 TYPHUS PEVER. CHAP. X. 

a real loss of vitality instead of being oppressed ; energy 
cannot be expanded, because irritability is exhausted. 

Hence it is of the greatest moment to be careful not to 
add the stimuli of medicaments to (he stimulating effects 
of the disease, even should adventitious circumstances 
seem to require them. The latter stage of fever can 
commonly be well enough managed, when stimuli have 
been avoided in the preceding course of it. When right 
measures have been used, and wrong measures avoided, 
the latter stages of fever are very manageable ; and if the 
physician has not the gratification of seeing his patient 
cured, so soon as he might choose, he will have the 
superlative pleasure of seeing him restored in due time. 

We have hitherto been speaking of negative practice ; 
the subject is copious ; it is time to turn our attention to 
a consideration of those remedies, which just physiolo- 
gical principles and attentive observation shall warrant. 

After what has been advanced in the previous chap- 
ters, and suggested in this, the treatment will be short. 
It will in the first place be observed, that there are not 
so many fevers and different kinds of management as 
some have inculcated. The general treatment of fe- 
ver is very similar; but much variety is necessary in 
adapting remedies to suit the degree of morbid excite- 
ment, and the personal circumstances of the patient. 
The hurtful causes are slow in operation, and conse- 
quently febrile excitement is moderate, compared with 
other fevers ; but the assertion before made will be re- 
peated, that the arterial action is above the healthy 
standard, and must be reduced. It is of no consequence 
for others to say, "that blood-letting is not to be employ- 
ed in simple typhus," when it has been employed so 



SECT. III. TYPHUS FEVER. 371 

repeatedly and for a scries of years to the present time, 
and with the most decided benefit. It has been my com- 
mon practice to bleed on the first day of the attack, or 
second, or third ; indeed at any time of the disease, that 
the symptoms may demand it. In cases, that have ap- 
peared to be overcome, and again assume any degree of 
violence, I have bled perhaps on all the days from the first 
to the twenty-fifth ; and if the bleedings are timely and 
adequate to the exigences of the case, the disease will, 
almost certainly, be overcome, in connection with other 
appropriate treatment. Some cases of mild aspect may 
do without bleeding; others with one, whilst others need 
three or four bleedings, in the course perhaps often or 
twenty days. 

AVhilst bleedings are denied the suffering patient, some 
have been relieved in a hazardous manner, as was lately 
reported by a professor in a lecture room, concerning a 
man in a delirium with typhus fever, who cut his own 
throat in such a manner as to bleed freely, which prov- 
ed not mortal, but he immediately recovered. 

Without taking the trouble of making tedious quota- 
tions from authors, two facts will he stated of impor- 
tance in the present argument; one is, that visceral 
inflammation is often present in typhus fevers; the 
other is, that we are not always admonished of the pre- 
sence of this inflammation by pain ; and it is said we 
are not possessed of any diagnostic symptom to detect 
it. It will however be suggested, that the quick pulse is 
demonstrative of its existence ; and further, that the 
after bleedings, showing a buff, are also characteristic. 

There is no remedy so suitable to relieve these con- 
sestions and inflammations in the head and viscera 



372 TYPHUS PEVER. CHAP. X. 

of the thorax and abdomen, as bleeding. Emetics and 
cathartics have their use, and, in some instances, are 
sufficient alone ; but a serious case attended with stupor, 
even if pain is absent, should not be risked without it. 
In the many hundred instances of the use of this remedy, 
in the present disease, not a single case has occurred to 
me, where it has appeared detrimental ; and it is a very 
rare occurrence for a case to go wrong, under the pro- 
posed management. Intestinal hemorrhages are pre- 
vented by adequate bleeding. It is an unfortunate cir- 
cumstance, that those cases, which might be relieved by 
this outlet, are from false theory usually followed by 
strong stimulants and tonics. In this case, what nature 
has restored, art has destroyed. 

The treatment is very simple in this disease ; when so 
managed as to avoid the formidable appearances, it 
assumes in the latter stages of severe cases. The sub- 
sultus tendinum is oftner from wrong management, par- 
ticularly opium, than from any thing necessarily con- 
nected with the disease. Diarrhcea should be treated 
more commonly with physic, than with opium and as- 
tringents. If the patient should be very faint and low, 
wine should be given in small quantities, as occasion 
may require, but seldom in the first stage of the dis- 
ease. 

All that has been observed previously, relative to the 
application of external warmth, will apply in this dis- 
ease. This should not be applied in excess, at any one 
time, but moderately at all times, except external heat 
and delirium are present. If the foregoing observations 
are well attended to, external heat and delirium will sel- 
dom be very alarming. External warmth and perspira- 



SECT. III. TYPHUS FEVER. 373 

tion should be assiduously attended to, but moderate in 
proportion, as the disease is wont to be dilatory. The 
patient should be kept warm more by external means, 
than internal stimuli, unless they arc of the most diffusi- 
ble kind. Custom has given to opium the character of 
a diffusible stimulus, whereas it is one of the most per- 
manent in the materia medica. 

Moderate emetics should be frequently employed ; 
perhaps every other evening, or according to circumstan- 
ces. If the patient should be oppressed with sickness at 
the stomach, or collection of viscid phlegm in the tra- 
chea, emetics may be used every evening. They should 
not have more than one or two operations. 

Cathartics should frequently be interposed ; generally 
of the moderate kind. In the first stages of the disease, 
calomel may be used for this purpose. 

The use of bleeding, emetics, and cathartics, should 
be apportioned to the circumstances of the case; never 
to exhaust the patient too greatly, yet they should be 
sufficient to overcome, along with external warmth, and 
with perspiration, the torpor of the surface and the 
internal congestions and inflammation. 

After febrile action is confirmed in the system, by 
some continuance, it seems to be the case, that it is ne- 
cessary for the system to become reduced to a certain 
point of lowness and impoverishment, before morbid 
irritability, or fever, ceases. If the state of disease is 
of a moderate kind, it continues, in its usual course, 
until the system becomes exhausted in length of time, by 
a waste of stimulant properties in the body, when disease 
ceases, and health is restored, attended with much lean- 
ness. If morbid irritability is reduced by proper reme- 



374 TYPHUS FEVER. CHAP. X. 

dies, according to the condition of the patient, much 
length of time may be saved, much plumpness of the 
body, and also much safety ensured. 

It becomes necessary to use, occasionally, various 
aperient and laxative medicines, in the course of the 
disease, and at intervals, when the patient is not under 
the operation of those medicines, which disturb the 
stomach. Of these, mention has been made in former 
chapters in part; sulphate of potash, nitrate of potash, 
cream of tartar, magnesia, soda, sulphur, &c. may be 
alternately used. Any of the saline substances may be 
made into a jalap. To quiet the restlessness and ere- 
thism, attending paroxysms of fever, something like 
the following maybe tried. Take camphor, one drachm, 
rubbed in a mortar with sugar, and a few drops of spirit ; 
after which, add four ounces each, of vinegar and water; 
this may be taken in about twenty-four hours. 

If a laxative febrifuge should be required, the follow- 
ing will be very useful. Take an ounce of sulphate of 
soda ; let it be dissolved in a wine quart of warm water ; 
drop into this about eighty drops of strong nitric acid, 
or enough moderately to acidulate it ; t^en add an ounce 
or two of loaf sugar, as is most agreeable to the patient. 
This may be taken often, in the quantity of a wine glass, 
until it proves laxative, or if this is not required, then 
more moderately. Many other alteratives might be 
mentioned, but the stomach should not be crowded with 
medicine ; it needs refreshing food and drink. 

If the symptoms should become mild after moderate 
depletion, at any time in the course of the disease, but 
little will need be done by way of medicine for several 
days, in many cases. Careful attention will be neeessa- 



SECT, III. TYPHUS FEVER. 375 

ry on the part of the attendants in every circumstance, 
relative to their charge. In this interval, the patient 
obtains a little ease from the disagreeable operation of 
medicine, and, perhaps, receives some refreshment, suit- 
ed to his condition ; and, if the fever has any exacerba- 
tion, he will more cheerfully submit to the use of reme- 
dies. 

In certain very low conditions, a little wine as men- 
tioned before, may be necessary ; also decoction of the 
bark; elixir vitriol; and Fowler's mineral solution. 
Constantly, in the whole course of the disease, the pa- 
tient may take mild and nutritious food, in small quanti- 
ties, as is agreeable, and generally in a liquid form, as 
broths, gruel, coffee, &c. It is not meant to be under- 
stood here, that such quantities should be taken, as to 
prove very stimulant, but sufficient to prevent faintness 5 
lowuess and faintness are much better avoided in this 
manner, than by stimulating cordials. If at any time, 
the food should oppress the stomach, it can be removed 
by gentle physic. Drinks, in the forepart of the disease, 
should be warm ,• and also at every stage, unless the 
patient has a strong desire for cold drink. 

In some cases, external heat will be pretty abundant, 
and connected with pain in the head, even after bleeding 
has been carried to a considerable extent. In such 
eases, wetting the head in cold water has sometimes 
given sudden relief. If the heat should be very consi- 
derable externally, which happens rarely, when the pro- 
posed method is followed, cold water, externally, may be 
tried ; see Chap. v. Sect 2. But in the many instances, 
in which I have seen it tried, it has appeared to be use- 
ful, only in a very few cases ; when used earlv in the 



376 TYPHUS FEVER. CHAP. X. 

disease, it has often manifestly been hurtful. Blistering 
is often useful, but not more than one at a time should 
be applied. 

When slow or typhus fever is treated with tonics and 
stimulants, it is very generally lengthened to a conside- 
rable extent. But this is not all ; it is common for peo- 
ple to say, they have never felt well as formerly after 
having the disease. Although they have escaped some 
incurable disease, as a sequel of fever, yet it is often the 
fact, that imperfect health is their constant attendant. 
More serious consequences remain to be told. I have 
seen a very considerable number of cases, attended with 
contraction of the muscles and tendons : the legs cannot 
be extended, nor the body raised to the perpendicular; 
decrepitude is depicted on the whole body. A diligent 
use of the warm bath, mild cathartics, emollient oint- 
ments, and moderate extension may restore these. Again, 
A long catalogue of maladies will be passed over, to 
meution only wasting consumptions and bloating drop- 
sies. These are very often the sequel of half cured 
Tevers, and the trophies of preposterous practice- No 
axiom in medicine is better established, than the asser- 
tion, that these diseases may be prevented by a judicious 
treatment of the primary affection. 

When this disease is treated upon the general princi- 
ples related, it is commonly disarmed of its violence, and 
becomes as harmless, as moderate eases of influenza. 
The writer is well aware of the preconceived opinions, 
and the weight of authorities, in favour of the use of 
calomel, wine, and opium, in large and small quantities, 
&c. ; nothing, but a thorough and well grounded convic- 
tion of their hurtful tendency, could have induced him 



SECT. III. TYPHUS FEVER. 377 

to oppose their use in a publick manner, and expose him- 
self to die disapprobation of some of the more candid, 
and to the obloquy of some of the more censorious part 
of the community. These conclusions have not been 
premature,* nor till after the most effectual trial by 
himself, and attention to the practice of others, has he 
been convinced, that the mild access of typhus is often 
converted by stimulants and tonics into a formidable, 
treacherous, and unmanageable disease. 



It was proposed to have made some particular obser- 
vations on influenza and intermitting fever * but want of 
room precludes them. After the occasional previous 
remarks, it becomes less necessary, as it respects influ- 
enza. Mr. Senac, is recommended as the best practical 
writer upon intermitting fevers. 



48 



REMARKS, &c. 



In all attempts to discover the causes and cures oF diseases, which, 
have been deemed incurable, a physician will do nothing effectual, 
until he acquire a perfect indifl^ence to his own interest and fame." 

Rush. 



ON FERRIS FULMONALIS, OR PHTHISIS FULMONALIS, 

OR j 

PULMONARY CONSUMPTION. 

Should a superficial reader look at these remarks on 
account of the novelty of the title, or name of the dis- 
ease, he is politely requested, either to lay down the 
book, or begin, and read it through. 

The symptoms of this disease, from its frequent 
occurrence, are too well known to every one to need de- 
scription. The most important will, occasionally, be 
alluded to in the course of this investigation. 

From one fourth to one third of adult persons, in tem- 
perate latitudes, die of this disease ,* except in severe 
epidemic seasons. In the united kingdom of Great Bri- 
tain, it is said, fifty thousand are annually swept away 
by it ; and, in the northern states of America, the pro- 
portion has been but little less ! If to this be added the 
deaths of those by other states of pneumonic iuflamma- 






PULMONARY CONSUMPTION. 379 

don, as pleurisy, influenza, &c. the number will be great- 
ly increased. 

The subject before us requires a volume ; but necessi- 
ty obliges our remarks to be compressed in narrow 
limits. They will consist of a few propositions, with 
some illustrations. 

1st. It is an endemic fever, affecting the inhabitants, 
almost exclusively, in certain districts and countries. 

It affects countries adjacent to the sea, more than in- 
land situations. But this admits of some exceptions. 
Lincolnshire in England is rarely affected with this dis- 
ease, although it is so frequent in that country, and this 
lies contiguous to the sea. The inland parts of Ireland 
and Holland are but rarely subject to the disease, al- 
though it is very frequent in these states. 

In this country, it will be suggested, that consump- 
tions are most frequent near the sea coast, and acute 
pneumonic inflammation more frequent in the interior. 
But the difference is not supposed to be great. The 
truth of this observation may be found in bills of 
mortality, and the well known fact, that the late pulmo- 
nic fever was more severe in the interior than on the 
sea coast. Certain parishes and districts, in the same 
county or state, produce a greater number of phthisical 
cases than others. Dr. Forsyth observes, (Med. Re- 
posit, for 1809, p. 353) on the diseases of the eastern 
part of Ohio, " The phthisis pulmonalis is, if possible, 
more common than on the sea coast." He imputes it to 
local influences. Territories, situated under the torrid 
and frigid zones, are more exempt from the disease ; in 
some of these places, it is almost unknown, but others 
are not wholly exempt. These facts are presumptive 



380 REMARKS ON 

proof, that particular local situations afford a predis- 
posing influence. In like manner, some situations pre- 
dispose to intermitting, some to yellow fever, &c. The 
external circumstances, inducing predisposition, are 
supposed to be certain elementary principles in the at- 
mosphere, of local, but of pretty extensive diffusion, in- 
ducing a peculiar state of susceptibility in the lungs,with 
slow external impression. The personal circumstances, 
giving an aptitude to this peculiar diseased action, are 
supposed to be, a greater degree of irritability of fibre, 
than is common to the generality of adult persons. This 
will be further considered in the next proposition. 

It will be suggested, that heat and cold, drought and 
moisture, should be considered principally as exciting 
causes ; they do not very commonly produce the disease, 
except in the predisposed. But suppose a person, pre- 
disposed by any circumstances inducing an irritability 
and mobility of constitution, to be placed in a variable 
and predisposing atmosphere, he will be in danger of re- 
ceiving a permanent impression, and suffering from such 
exposure. A moist and cold atmosphere is, therefore, 
liable to excite the disease ; as also sudden changes of 
weather in cold climates. Small impressions, on the 
surface of the body, inducing but slight changes, called 
colds, also impressions more slight, and scarcely noticed 
at first, lay the foundation of this formidable disease. 
Hence arises the necessity of all persons, more especial- 
ly invalids, dressing warm, and avoiding cold, damp, and 
foggy air ; also variable weather with cold winds. And 
likewise, if they gain an impression in the form of a 
cold or slight cough, to use diligence to remove it before 
chauges of a more serious aspect occur. A cold is a lit- 



PULMONARY CONSUMPTION. 08L 

lie fever ; it may be easily cured, or it may readily be 
transformed, in certain habits, into a consumption. It is 
curious (o notice certain people, in bed when they happen 
to have less bed covering, or happen to led a change of 
weather, afflicted with a frequent cough. Let such have 
an additional covering, and the cough immediately 
ceases. This goes to prove the theory of fever, and 
shows the importance of the functions of the skin in the 
economy of the system. 

Some seasons of the year afford a greater number of 
consumptions than others. And also some periods of 
time produce a greater proportion than others. Since 
the appearance of the late epidemics, for about five years 
past, consumptions of slow origin have been less fre- 
quent in this vicinity than before.* The greatest pro- 
portion have been such as are the sequel of pneumonia, 
and these have not been so frequent as from former 
cases of sporadic pneumonia. These and many other 
circumstances that might be mentioned, go to show, that 
this disease depends more upon elementary, than per- 
sonal predisposition. 

2d. It affects people of the most exquisite irritability 
of fibre. 

This proposition may admit of many exceptions, so far 
as we are able to discover a state of irritability in the 
general habit. It will, however, hold good as a general 
rule ; and in the exceptions that might be made, it will 
be suggested, that although the particular person might 
not so clearly discover a general mobility of constitution, 

* The reader is requested to see Chap 11. under the year 
1814, relative to an opposite opinion of the frequency of 
this disease, by Dr. Littlefield, in Bennington county. 



382 KEMARKS ON 

Le may possess a peculiar and local irritability in the 
lungs. This is far more probable than the common opi- 
nion, that a deformed chest gives a liability ; for it is a 
matter of notoriety, that many people, having very flat 
chests, high shoulders, and long necks, do not have the 
disease; and it can hardly be said, they arc more sub- 
ject than others to it; otherwise than as this particular 
form is presumptive, that the person is of a slender or 
delicate temperament, and, consequently, possesses a 
greater degree of mobility and irritability of fibre. 
Many persons, having great deformity in the chest, 
from rickets and accidental injuries, are not more fre- 
quently seized with this disease than others. The most 
decided marks of this kind of delicate irritability, are a 
fine smooth skin, a fair ruddy complexion, leanness of 
body, a great flow of spirits, acuteness of understanding, 
and an amiable disposition. It is said to affect more of 
the female than of the male sex. Although the subjects 
of this temperament may be most liable to the disease, it 
may and does affect all temperaments and complexions. 
It appears most at an age when it is presumable that 
the system suffers most from sanguineous plethora, giv- 
ing a high degree of irritability. From the age of six- 
teen to forty, is the period when the greatest number by 
far, are affected with this disease. Until the age of 
about sixteen, superabundant increment is applied to the 
growth of the body ; after the age of about forty, the 
sanguineous incrementive powers become deficient. This 
is conformable to the well acknowledged fact, that preg- 
nancy even suspends the progress of the disease, when 
the increment is applied to the growth of the child, and 
local irritability is translated to another organ. As 



PULMONARY CONSUMPTION. 385 

soon as (ho internal economy is changed, the disease as- 
BUMS U« fcrmer ravages. Conditions of hard labour 
and scanty fare, do not produce so many consumptions, 
as indolence and luxury. Upon the same principle, much 
riding and milk diet, or low regimen, have been found 
useful oftentimes in the cure and prevention. 

A further argument may be added here, as proof that 
many people, who have had incipient phthisis, have been 
relieved, and others whose disease had made great pro- 
gress, have been cured, by means that diminish irritabi- 
lity, by a subduction of stimuli. 

Salivation, by giving a severe impression in the throat 
with a discharge of saliva, appears to have, oftentimes, 
au effect analogous to pregnancy ; and most commonly 
after salivation ceases, the disease returns with violence 
proportioned to the delay. The great secret of the me- 
thodus medendi seems to be, to translate diseased action 
from the lungs, and sustain it permanently, without in- 
jury to any other organ, until the primary derangements 
are removed. 

3d. It is a primary and idiopathic fever, having a 
locality in the lungs. 

The tardiness of the disease is no argument against its 
pyrexial character. The plague is called a fever; so is 
typhus ; the former kills, sometimes, in a few hours ; 
the latter sometimes not until the end of an hundred 
days. There is as much propriety in considering this 
an original or primary fever, as there is in calling the 
most rapid case of pneumonia such. The symptoms are 
exactly alike, making allowance for the rapidity of the 
one, and the tardiness of the other. 

It is called hectic, which onlv means habitual. The 



384 KEMAKKS OS 

name is well enough ; for it follows the afflicted through 
all his time, and all his travels, from the first day of his 
seizure to his tomh, if not wrested from hiin by some 
friendly hand. Nothing but superficial observation, 
and submission to the errours of others, has induced any 
one not to call the fever hectic, until pus is expectorated. 
It is true some change happens in the symptoms, at the 
time the patient raises purulent matter, but they are 
only such as mark a higher grade of disease, with ulce- 
rated surfaces exposed to the air. From the weakened 
faltering state of the patient, and aggravation of disease, 
remissions become more apparent, and the accession of 
paroxysms more distinctly marked. A difference in the 
fever attending pneumonia may easily be discovered be- 
tween the first attack and the after progress. In the 
pulmonic fever in the winter of 1812 — 13, patients would 
often have the deep circumscribed flush in the cheeks, 
within seven days from the first attack, and exactly re- 
sembling the most decided hectic ; whilst at the same 
time, they were doing well, and the fever vanishing, 
with a free expectoration of muco-purulent matter. 

The existence of fever, in the attack of consumption, 
is inferred from the symptoms, which are almost con- 
stantly a heat in the palms of the hands, dryness of the 
skin, a flushing sometimes in the cheeks, more or less 
acute pain in the region of the thorax, attended frequent- 
ly with hoarseness and shortness of breath, occasional 
chilly sensations, and particularly a quick pulse. These 
symptoms sufficiently evince the existence of fever, and 
ought so to be called instead of debility, which is only a 
symptom. The fever is constant every day, and may 
well be called hectic or habitual. As a conclusive argu- 



PULMONARY CONSUMPTION. 3b5 

mcnt, that purulency is not necessary to constitute a hec- 
tic fever, it will be noticed, that some cases have proved 
fatal, and after a long time, without any purulent expec- 
toration; or even a discharge of mucus, except in very 
small quantity. 

There is no propriety in saying, the present disease is 
caused by debility. We may as well say, all diseases 
are caused by debility ; and agree to use this undefined 
and pliant word as a garment, with a woof of charity, to 
cover all our iguoranee. The lowest grade of direct 
weakness, free from fever, is not oftener followed by this 
disease, than the highest state of vigour compatible 
with health. In cases of the greatest exhaustion or in- 
action, If the patient survives the first shock, he is 
almost sure to recover perfect health, with prudent ma- 
nagement. Those cases of chronic disease, following 
fever, originate not from debility, but from the fever be- 
ing only partially cured, and oftentimes from a transla- 
tion of diseased action to some other organ. 

We hear of rheumatism, gout, eruptions, typhus fe- 
vers, &c. inducing debility, and consequently oftentimes 
consumptions. If these primary diseases had been eli- 
minated from the system, by proper remedies, although 
the patient had been very low and debilitated, he would 
not be followed by consumption $ and, I am warranted 
in saying, by no other formidable disease I am free to 
pledge myself for the truth of this remark, in general 
terms. The obscure pretence of debility, causing so 
many diseases, ought to be exposed, and no longer per- 
mitted to be the city of refuge for ignorance and errour. 
Debility exists, as a symptom, in a great proportion of 
diseases, and we ought to look a little further back m 

49 



386 REMARKS Off 

the chain of cause and effect, and attempt to discover 
what induces this debility, and there look for the cause 
not only of debility, but of many other of the symptoms 
of this unrelenting disease. 

The suggestions of those who consider the fever in 
this disease symptomatic, are ill grounded. This is 
inferred partly from what has been said; and partly 
from this, that the local affection in the lungs and the 
general fever are synchronous; the analogy with all 
other febrile diseases, confirms this. If there should 
happen to be any material defect in the lungs, or even 
recent wound, and the system free from fever or a gene- 
ral morbid action, but little inconvenience will ensue ; 
but suppose the reverse; let a general inflammatory 
diathesis be present, and consumption will be likely to 
follow. In this manner, hemoptysis may be harmless, 
if no inflammatory diathesis be present, nor any other 
derangement in the lungs, except the simple lesion, pro- 
ducing the discharge of blood. 

From the circumstances, that the disease affects most- 
ly the inhabitants of certain districts; that it affects 
people of a certain age and temperament, having a pre- 
disposition ; that the fever and affection of the lungs are 
synchronous ; that they progress together, and termi- 
nate together ; and that the symptoms are, in common, 
with other fevers, we are induced to consider this a 
general fever having a locality in the lungs ; or chronic 
pulmonary fever. 

4th. The assigned causes of consumptions are not 
the real ones. 

The causes of consumptions have, by modern writers, 
been considered to be five : viz. hemoptysis or spitting ■ 
of blood; pneumonia, ending in suppuration; catarrh; 



PULMONAKY CONSUMPTION. 387 

Mthma ; tubercles. Each of these require a short con- 
sideration. 

a. Hemoptysis. This, or other discharge of hlood 
from the lungs by wound, is harmless, disconnected with 
a febrile diathesis. This is agreeable to observation 
and the opinion of the best practitioners. If inflamma- 
tion should supervene, it may be suppressed, and (he part 
heal and not be followed by consumption. It is suppos- 
ed that in all eases of spitting blood, connected with or 
followed by consumption, that the disease has made some 
advance before this appears, and therefore should be con- 
sidered only a symptom of the disease; and sometimes a 
fortunate one, provided enough is lost to break the in- 
flammatory diathesis, which is rare. Sometimes the 
conges; ions of blood in the lungs afford the spittiug at 
an early period ; at other times not until the disease is 
far advanced. On account of the lungs being formed of 
a great proportion of cellular texture of less sensibility, 
and of a yielding fabric, derangements in this organ, 
when slowly formed, are not soon noticed by the patient. 
Hemoptysis may be one of the first obvious symptoms, 
though following primary derangements. 

Spitting of blood in consumption is from the same 
cause, and from the same condition of the lungs, that it 
is in pneumonia. They both appear after some change 
is made in the lungs by the disease. Pain is slight even 
in pneumonia, unless the investing membranes are affect- 
ed ; much less in phthisis. In this condition, blood is 
spit oftentimes before the patient is warned of his case 
by pain; but a quick pulse and other signs of general 
disease may be observed. 

b. Pneumonia ending in suppuration. This is nothing 
more than a protracted case of the same disease. The 



jSS remarks on 

one is an acute phthisis, the other a chronic or pro- 
tracted phthisis. It might be called fcbris pulmonalis 
in the suppurative stage. If the patient had died before 
suppuration, it might be called pneumonia, or febris 
pulmonalis without suppuration. IVo more propriety 
exists for calling pneumonic ulceration by some other 
name, and considering it a different disease, than there 
would be in calling an external ulcer, which opened in 
ten days by another name, after it had existed an hun- 
dred days. 

c. Catarrh ; or what is perhaps the same, influenza. 
This has some affinity to pneumonia, but of a less violent 
character, and affecting, more especially, the fauces aud 
trachea. The inflammation may reach into the remotest 
air cells of the lungs, and if protracted, occasion a puru- 
lent discharge from the inflamed membranes. This 
disease continuing, the abrasions consume the mem- 
branes, and deep ulcerations are sometimes formed. 
This is consumption or protracted catarrh. The case 
may prove fatal without a lesion of the membranes. 

d. Asthma. This is not usually attended with fever. 
If hectic fever attacks an asthmatic person, the habitual 
irritable state of the lungs renders it more difficult, but 
does not cause it. 

e. Tubercles. These are said to be the most frequent 
cause of phthisis. They very commonly attend the 
disease ; but it will be suggested, that they are oftner 
the effect of diseased action of the vessels of the lungs, 
than the cause of the disease. In the various dissec- 
tious, which have fallen uuder my observation of per- 
sons, dying of other diseases, these tumors are not 
found of the same kind with those found in the case of 
dissections of phthisis; neither so frequently met with 



PULMONARY CONSUMPTION. f»89 

as might be supposed, if they existed a long time before 
the attack of the disease. It is rare to find any tumors 
in loch subjects ; when they do appear they are of a 
larger size, and not affected with inflammation. These 
may have some resemblance to scrofula, and arc suppos- 
ed innocent, as they are few in number and not inflamed. 
The tubercles in patients with lingering phthisis are 
very numerous and small ; they rarely appear in violent 
cases, approaching to the nature of pneumonia, but in 
the most protracted. The convoluted glands of the 
lungs are supposed to be easily affected by a slight and 
peculiar inflammation soon after the attack of the dis- 
ease, and tubercles are suddenly formed, and which 
render the disease more obstinate. In severe cases of 
pneumonia the inflammation occupies a considerable 
9pace, including the blood vessels, &c. in one common 
mass of inflammation, which soon suppurates and is ex- 
pectorated ; or if the air cells above should adhere by 
the inflammation, the pus will collect in a vomica. 

Scrofula is a very rare disease in this country ; but 
phthisis pulmonalis a very frequent disease, and very 
often of that species, attended with tubercles. Their 
formation is supposed to be after the manner of the 
swelling of lymphatic glands in the groin, or armpit, or 
neck from a slight inflammation below. These are sud- 
denly formed and suddenly disappear ,• so it will be sug- 
gested, the tubercles in the lungs will disappear, if the 
primary disease, or fever is seasonably removed. This 
may be hard to prove ; but analogy warrants it| also 
many cases, where the existence of tubercles has been 
strongly suspected, have been cured. This kind of tu- 
bercles is more likely to inflame and suppurate than the 



3.90 KEMA.HKS ON" 

scrofulous, and arc connected with, and in a great mea- 
sure dependent upon fever, for their continuance and 
progress. Scrofula, on the other hand, is rarely attend- 
ed with fever; and the swellings, when ulcerated arc 
free from inflammation. So much is this the case, that 
the most of the remedies recommended for their healing, 
consist in such, as produce inflammation in the part, 
which is thought necessary to their healing. And also 
as respects the general treatment; bark, iron, and other 
stimulants are recommended. If these do no good, they 
are harmless. This is more than can be said of phthi- 
sis, for, where stimulants and tonics are used in this 
disease, the patient rarely escapes with impunity, or the 
physician without disappointment. 

Scrofula is so rare a disease in this country, that I 
am verily of opinion, that not one case in thirty of phthi- 
sis, which I have seen, showed any signs of scrofula ex- 
ternally by tumors, neither had the patients ever been 
troubled with it in the course of their lives. Dr. Cullen, 
and others, admit, that tubercles maybe formed by other 
causes than scrofula ; particularly from the fomes of 
small pox and measles; this is acknowledged from the 
appearance in dissections. In order to support the fa- 
vourite theory of tubercles being the cause of the dis- 
ease, it is said, « these diseases afford a matter, which in 
the first place produce tubercles. 5 ' It is surprising some- 
times, how near some people come to the truth, and yet 
miss it. It is granted, that tubercles are early formed 
in phthisis, not only from the above diseases, but from 
many others imperfectly cured, as typhus, influenza, &c. 
not from any specific acrimony or fomes, but as a conse- 
quence of a particular kind or degree of inflammatory 



Tl'LMONAKY CONSUMPTION. 391 

action, in the vascular and glandular texture of the 
lungs. Tubercles show very nearly the same appear- 
ance, from whatever causes produced. 

A further circumstance, showing that tubercles are 
not of a scrofulous character, may be inferred from tue 
matter raised from the lungs in phthisis; this is very 
strictly a purulent matter, in the advanced stages with a 
mixture of mucus ; in scrofulous sores, the discharge is 
more strictly mucous, or rather gelatinous, or watery. 
Although both phthisis and scrofula appear most fre- 
quently in the temperate latitudes, and similar tempera- 
ments, yet it is well known, that scrofula is a disease of 
nonage and laxity, whilst phthisis affects the sanguine 
and sthenic, age of manhood. 

And further, scrofula is not connected with fever 
until very late in the disease, and then is not violent. 
On the other hand, phthisis is accompanied with fever 
from the beginning. 

By this time, it might be expected, that any one, who 
iinds so many defects in the assigned causes of phthisis 
pulraonalis, should give satisfactory proofs of the real 
causes. The causes of fever still continue to be a great 
desideratum amongst the faculty, even in such diseases 
as attack suddenly and are rapid in their course. To 
ascertain correctly the remote and primary causes of a 
disease, of the insidious approach and procrastinated 
termination of the present, may be considered more dif- 
ficult. 

The views of the writer have, undoubtedly, been anti- 
cipated before now. The following proposition will be 
offered, as the most satisfactory opinion he has been able 
to form. 



392 HEMARKS ON 

BtU. It has an elementary origin, in some measure, 
like other fevers of a general character and local ten- 
dency. This is inferred — 1st. From its analogy to pul- 
monic epidemics ; 2d. From its affecting subjects of the 
same temperament ; 3d. From its appearing principally 
in certain countries and districts; 4th. From its being 
attended with the precursory symptoms of fever; 5th. 
From its being mitigated or cured by the same remedies 
as other elementary diseases; 6th. From its being ex- 
cited by the same causes ; 7th. From other fevers 
changing into this ; 8th. From some periods of time 
affording a greater number of cases than others. 

The tardy progress of the disease is no objectiou. The 
causes are supposed to be slight and permanent ; and 
in many respects it resembles typhus. This last often 
affects the lungs very considerably, and when only half 
cured, often terminates in phthisis. Chronic eruptions 
being translated from the surface to the lungs, often fix 
the locality there, when connected with an inflammatory 
diathesis. 

Much has been said about other diseases causing the 
consumption. The solution of the fact seems to be this y 
Diseases are apt to change their locality, in a forming 
state, and also when partly cured, more readily than in 
their strongest state ; the locality, in these conditions, 
(manges from place to place ; and in a subject possessing 
any particular irritability of the lungs, it may settle 
there, and with or without tubercles being formed, be- 
come difficult to cure. 

In cases of slow and imperceptible approach, the ex- 
citing causes are supposed to be such, as make a slight 
and partial derangement in the minutest vessels of the 



PULMONARY CONSUMPTION. 393 

system. See Chap. in. Sect. 6. Also Chap. v. latter 
part of Sect. 3. 

The disease appearing chiefly in certain districts, in 
the same latitude, gives a strong presumption, that some 
deleterious elementary principle is necessary to its pro- 
duction. Its appearing mostly in the middle latitudes, 
is presumptive, that the extreme and sudden changes of 
temperature, from heat to cold, and the reverse, have a 
controlling influence. 

As all exciting causes of fever have a greater influence 
in debilitated habits, so this disease finds a more ready 
access to such habits of an irritable fibre. The nume- 
rous circumstances, which act upon the body, producing 
more or less derangement in the economy of the system^ 
cannot be repeated here; they have been referred to, as 
the common exciting causes of fever. It will only be 
noticed, that the concurrent operation of cold is necessa- 
ry to give permanency to the derangement in the minute 
vessels. 

It will be suggested, that cold and moisture act only as 
exciting causes. It is not very common for them to pro- 
duce it, but in the predisposed. Such persons as have a 
natural or acquired condition of pulmonic susceptibility, 
are liable to have slight pulmonic inflammation, upon the 
slightest application of exciting causes. The derange- 
ment in the circulatory system is slight, but permanent. 
It gains permanency by continuance. As typhus fever 
is to the shortest and most violent fever, so is febris pul- 
monalis to typhus. See definition of fever, Chap. iv. 
Sect. 1. 

The local affection is an adventitious circumstance, or 
depends upon some personality of the patient, either na- 

50 



394 REMARKS ON 

tural from ancestors, or acquired from climacteric influ- 
ences ; most commonly the latter. The local affection 
does not always fall upon the lungs, in cases of protract- 
ed or chronic fever ; it may fall upon the liver, under 
certain climacteric influences; or it may fall upon the 
mesentery, producing another kind of consumption ; and 
so of many other diseases of slow progression. These 
may all be attended with fever; and although the local 
affection merits particular consideration, the circum- 
stance of fever, or general diseased action, merits princi- 
pal regard in the treatment. 

Extraneous bodies accidentally lodged in the bronchial 
vessels, such as beans, splinters of wood, &c. as also cal- 
careous concretions in the coats of the air vessels, some- 
times induce inflammation in the lungs and a distillation 
of purulent matter,with wasting, &c. If these can he re- 
moved the disease ceases, the same as in injuries in other 
parts of the body. If they are not removed, sooner or 
later destroy the patient, as similar extraneous bodies 
may do in other important organs. 

With respect to the primary cause, little need be offer- 
ed, after the previous suggestions. The derangement 
in the minute vessels is small ; like other fevers, secon- 
dary consequences follow ; the whole system becomes 
diseased, with a local inflammation in the lungs of a 
chronic kind, attended with wasting and destruction, if 
not arrested. 

6th. The treatment should be similar to other fevers; 
having regard to the permanency of the disease, the local 
affection, and personalities of the patient. 

This disease has been called the scourge of physicians. 
It may be doubted whether the treatment has not been as 



PULMONARY CONSUMPTION. 395 

often the scourge of patients. Without any design, per- 
haps, but to do good, almost all the articles of the three 
natural kingdoms have been applied to find specifics; and 
with as little success, and as little judgment, as the al- 
clmnisfs pursued their experiments to find the philoso- 
pher's stone. Notwithstanding the numerous unprofita- 
ble experiments of ancient time, great improvement has 
been made in the treatment, by the discernment and in- 
dustry of eminent men in modern times. 

Empyricks, quacks, impostors, mountebanks, horse- 
doctors, and patentees, have imposed, upon credulous 
and suffering patients, their never-failing tinctures, es- 
sences, sirups, balsams, lozenges, anodynes, pulmonic 
detergents, nostrums, catholicons, &c. These are only 
named to be placed in the back ground, along with their 
well merited contempt, and as monuments of ignorance 
and duplicity. 

Whilst mystery is attached to the character of any 
disease, the treatment is involved in uncertainty and con- 
fusion. If these pages should remove one mystical errour 
relating to this destructive malady, the labour and soli- 
citude of the writer will be compensated. 

7th. The progress of the disease depends upon the 
state of the fever. 

This assertion will hold good in every stage of the 
disease, but is most manifest, and most proveable in the 
first stages. As the depravations in the lungs are syn- 
chronous with, and depend on, the derangements in the 
general system, as before suggested, a principal object 
will be to restore the primary and general derangements. 
This will hold good, whether the disease be a sequel of 
some other, or whether it should originate in the more 



396 KKMAKKS ON 

ordinary way, from slow, and often imperceptible de- 
rangements as a consequence of external elementary 
impressions. 

It will be granted, that incases of moderate accession, 
the cough is often the first ostensible symptom ; but it 
will be suggested, that it is not really a symptom of pre- 
cedence. The patient may deny that he is indisposed ; 
and he will often deny that he has a cough, from the 
circumstance of its being so slight and habitual, that he 
does not notice it. In all these cases, by a strict exami- 
nation, it will appear, that the patient has some quick- 
ness of pulse ; some slight and transient pain ; some de- 
sire, occasionally, to avoid cold air; some dryness on the 
skin ; and a slight occasional flushing in the cheeks, with 
transient heat. 

If the disease is the sequel of some other pyrexial dis- 
ease, whose local affection is translated to the lungs, the 
progress of the disease will still depend upon the state of 
the fever. If the state of fever in the general system is 
removed, in either of the above conditions, the state of 
the lungs is of little consequence, as to the safety of the 
patient $ but it may be of much consequence, as respects 
his entire recovery. 

If the fever can be removed, before ulceration takes 
place, his cure may be complete. If not removed, until 
ulceration has taken place, his cure will be more or less 
complete, according as the ulcerations may more or less 
completely heal. Many live to a great age, with a defect 
in the lungs, giving some expectoration, with only, occa- 
sionally, a very little fever. 

8th* It becomes, therefore, of the first importance to 
use assiduously those remedies, found by experience to 
be most effectual for the removal of fever* 



PULMONARY CONSUMPTION. 397 

It will be understood, that our observations on the 
cure of (his disease, are meant to apply to the disease 
when formed in such a manner as to warrant the case 
to be phthisis pulmonalis in its incipient stage. It is 
supposed to be some weeks or months from the first in- 
disposition. And here it may be observed, that at first, 
this disease may often be averted by simple and slight 
measures. It often appears in the form of a slight cold, 
when a little attention to remove this, will remove the 
primary derangements in the system, with all their trou- 
blesome consequences. It must further be understood, 
that the remedies of incipient phthisis are the same, with 
a little variation, as the principal remedies in the after 
or ulcerated stage, as long as any hope remains of the 
patient's recovery. 

The principal remedies of febrile action have been 
treated of in the foregoing chapters, but, as applying to 
this peculiar state of disease, may require some further 
consideration. 

The same great leading objects should be kept in 
mind, to restore the primary derangements in the sys- 
tem, and preserve that important organ, the lungs, from 
destruction. If the primary cause can be removed, as 
before observed, in due season, the lungs may be pre- 
served ; and the fulfilling the forepart of our indication, 
supersedes the latter. The most essential remedies, to 
fulfil the above intentions, will be mentioned in succes- 
sion. 

a. Warmth. It is a disease of cold and variable cli- 
mates. The greatest proportion of attacks are in the 
cold season of the year. The patient seeks external 
warmth. A steady warm climate, warm clothing, and 



&9H REMARKS ON 

warm apartments, are found beneficial. Strict regard 
should be paid to the circumstance of external warmth, 
and the promotion of excitement, with moderate perspi- 
ration. Occasionally, and in case of dry skin attended 
with frequent pain, a tepid bath may be used. 

As in typhus fever, warmth should be used less severe, 
and more steadily, than in fevers of sudden access ; so in 
phthisis, it should be more moderate and well persisted 
in, as the case is more protracted. 

b. Blisters and frictions. For [the same intention 
of increasing excitement on the surface, these should 
steadily be employed. A blister every third or fourth 
day, principally on the chest ; and frictions over the 
whole body two or three times a day, or as the patient 
may bear them. 

c. Venesection. This should be employed more or 
less extensively, according to the severity of the case and 
personal circumstances of the patient. It ought to be 
persisted in, until pain is totally removed, and quickness 
of pulse is very considerably reduced, in conjunction with 
other remedies and suitable time. The bleedings should 
be repeated in as quick succession, as the pain and fulness 
of pulse return, after the former bleeding. The oftener 
the bleedings are repeated, and the larger the quantity 
compatible with the patient's particular condition, the 
sooner relief may be obtained. 

No regard should be paid to the huffy appearance of 
the blood. Bleeding is often very necessary, when this 
does not appear, particularly in the beginning; and after- 
wards, it may not be prudent to take blood until there is 
no appearance of buff. In some stages of fever, and in 
(his fever, the buff will probably appear in the last ounce 



PULMONARY CONSUMPTION. 399 

of Mood that could be drawn. After the violence of dis- 
eased aetion is broken by bleeding, the remaining cure 
should be trusted to other auxiliary remedies, with a 
suitable length of time for healthy adaptations to be re- 
stored. 

No attention should be paid to the splenetic notions of 
those squeamish writers, who recommend halfway bleed- 
ing, along with other halfway measures. "A moderate 
bleeding," say they, " when the pulse is unusually hard, 
is often proper." It may as well be wholly neglected, as 
to be used in this manner. After the disease has become 
incurable, the bleedings should be moderate, merely to 
palliate, neither should they be very often repeated ; but 
whilst there is hope of recovery, they should be tho- 
roughly persisted in. The case may be hopeful, and 
many have recovered, by suitable remedies, after very 
copious expectoration has taken place. This, therefore, 
is not a sufficient objection to the use of this remedy. 
The chance of success, however, is diminished in propor- 
tion to the length of time that has elapsed before the 
use of proper remedies. 

Debility is not so great in this disease as in some 
others, where bleeding will be acknowledged proper, and 
where it will be practised to a great extent in a few days, 
even by the same characters, who oppose it in this dis- 
ease. The patient is daily growing weaker by his dis- 
ease, and if he is only moderately bled, he is very apt to 
think the bleeding has weakened him. A faithful phy- 
sician has burden enough to oppose gainsayers, to quiet 
the fears of his patient, to retain his confidence, and ac- 
quit his own responsibility. He should look beyond pre- 
sent embarrassments, even to the end of the case, and 
there hope for consolation. 



*0U KEMAKKS ON 

The quantity and repetition of the bleedings should 
aeeord with the circumstances of the particular case. 
No rule can be given as to this ; some cases will require, 
perhaps, five bleedings in as many weeks, and each 
bleeding sufficiently large to make a manifest change in 
the hardness of the pulse and severity of pain. Another 
case may require perhaps ten, fifteen, or twenty bleed- 
ings, in the course of six or nine months. It is not usual 
to go beyond this in common cases ; but some very un- 
common cases may require a larger extent. It is asto- 
nishing to a person, not in the habit of using this remedy 
in its fullest extent, to notice the suddenness that ple- 
nitude and arterial action return, after a loss of blood, 
and whilst disease remains. It may here be observed, 
that after morbid excitement has subsided, no danger 
may be apprehended from the loss of blood inducing a 
plethora. I have not noticed any such consequence dur- 
ing the many years in which I have been in the habit of 
using this remedy. After patients have recovered from 
this and other diseases by repeated bleedings, they no 
more require after bleedings to remove plethora than 
other people. 

A specious argument is opposed by some against blood- 
letting in this disease, as also in many other diseases; 
that although it may be useful in nothern latitudes, and 
in the most sanguine habits, they say, that it is inadmis- 
sible in southern latitudes, and in old countries where 
effeminacy is more characteristic ; and particularly in 
the more slender and debilitated habits. The character 
of diseases is generally more rapid in southern latitudes ; 
and we have reason to believe, from the reports of the 
most expert practitioners of those countries, in other 



PULMONARY CONSUMPTION. 101 

diseases, that (be safest and most effectual treatment 
consists in a sudden subduction of morbid irritability, 
which is principally effected by blood-letting. It is hard- 
ly possible to conceive why the disease under considera- 
tion should be an exception. ^ 

If it be insisted, that the northern states of America 
afford a less proportion of effeminate habits, than the 
European countries ; it must be granted, that in the for- 
mer, many are to be found possessing a delicacy of habit 
and effeminacy of constitution not surpassed by those of 
modern Europe. , - 

With respect to individuals of this description, we are 
at liberty to offer an opinion. It will be affirmed, that 
subjects of this cast require blood-letting to a degree 
proportioned to their arterial plenitude and irritability, 
as much, and indeed rather more, than others of a more 
firm and less moveable habit. It is understood, that 
they may not need so many pounds of blood taken ; but 
what they can spare requires to be taken for their relief, 
as necessarily as from the opposite characters. It has 
often appeared to me, that a greater necessity exists for 
this evacuation in such habits, on account of a greater 
degree of arterial irritability accompanying them. A 
florid complexion and plumpness of body, should be no 
criterion to determine the propriety of blood-letting ; 
but a frequent pulse with only slight hardness, let it be 
ever so small, will warrant it in this disease, in any age, 
sex, constitution, or complexion. A slender texture, 
distended to a certain degree, will suffer more than a 
firm texture ; and the consequences of diseased action 
arc more certainly destructive, and less easily repaired. 
I have frequently treated cases of phthisis in these deli- 
st 



i02 REMARKS ON 

cate habits by bleeding, with advantage beyond my most 
sanguine expectations. 

Our opinion eventually amounts to this — That if, in 
most cases of this disease, the action of the system can 
be reduced, by blood-letting and other remedies, below 
the point of morbid irritability, before excitability is ex- 
hausted, or the lungs too greatly injured, the patient may 
be restored ; if otherwise, the disease may be beyond 
human control. 

d. Emetics. These are useful auxiliaries. They ex- 
cite the torpid lymphatics into action, and are useful to 
make a determination to the surface, and promote a dia^ 
phoresis. They are particularly useful in exciting a dis- 
charge from the bronchial lymphatics, whereby inflam- 
mation is relieved. In the incipient stages, tartarized 
antimony, or antimonial wine is preferred. In the after 
stages, with much debility and great expectoration, the 
sulphate of copper and ipecacuanha are preferred ; one 
part of the former, and two of the latter. Two or four 
grains make a sudden, easy, and useful emetic. I have 
known patients take an emetic of this every evening in 
bed, for two months, and gain strength the whole time; 
and even in cases of large expectoration ; whilst this 
would be gradually diminishing. The emetic operations 
should be slight, and repeated about every day, if nothing 
particular prevents. It may sometimes be repeated 
twice a day, for a short period. 

e. Cathartics. These must be used but very sparingly. 
Occasionally, however, they become useful as assistants ; 
when they become necessary, the mildest will be suffi- 
cient. 

These are the principal remedies to make a radical 



PULMONARY CONSUMPTION. *0J 

change in (he system ; to destroy morbid excitement, 
and give opportunity for healthy action to proceed with 
ease and regularity. As a proof that strong impres- 
sions and severe agitations are necessary to remove the 
primary derangement in this disease, it will only be men- 
tioned that accidental and sudden cures have been effect- 
ed by great terror \ as took place at Barbadoes in a hur- 
ricane in 17S0, according to Dr. Blanc. Van Swieteiv 
and Smollet, according to Rush, mention cures of con- 
sumption by patients falling into streams of cold water. 
This also proves the theory of the disease ; and the same 
thing has happened in other fevers. Several other re- 
medies become useful auxiliaries in this peculiar habit 
of disease, which will now be named. 

f. Low regimen. By this is meant a diet moderately 
nutritious, but void of the more stimulating materials. 
It is of great consequence that the patient be well sup- 
plied with agreeable food, and often repeated. Milk 
appears to possess more useful qualities, than any one 
single article. It is found by the experience of ages, 
that this article of food gives the most nourishment 
with the least febrile commotion. Patients should ge- 
nerally be strictly confined to it, with simple light 
bread. It may be prepared in any manner to suit the 
appetite. If the curative measures are properly persist- 
ed in, there will be no necessity of seeking for different 
kinds of milk, less stimulating than the milk of cows. 
Vegetable diet should be persisted in j consisting of the 
farinacea, herbs, fruits, and roots of common culture 
and culinary use. In some cases of very quick pulse 
and much irritability, simple milk alone for food, and 
a hey for drink, should be enjoined. In certain very low 



40* KEMABKS Olf 

states, and also after hope of recovery is relinquished, if 
the patient should have a particular desire for more 
nourishing food, as meat, oysters, &c. he may be indulg- 
ed; and if the force of disease should have been princi- 
pally subdued by proper remedies, they may assist his 
convalescence. 

The Iceland moss is considered an agreeable and pro- 
per article of diet, in the latter stages of this disease. It 
may be boiled in milk and water. 

g. Exercise. This consists of rocking, swinging, sail- 
ing, riding on horseback or in a carriage, walking, and 
hard labour. Much depends on the time and manner of 
using these. They may be useful, or they may be hurt- 
ful. The most gentle kinds, as rocking and swinging, 
may be useful at any time ; but the exercise should be 
very moderate in the beginning of the disease. I have 
never known riding on horseback of any use where there 
was any considerable fever, with quickness of pulse ; or 
until the force of the disease had been chiefly subdued, 
by the principal remedies. The inculcation of this re- 
medy, in the incipient stages, has been often attended 
with much injury. All exercise proves useful by excit- 
ing universal action, and a determination to the surface 
and extremities. The condition of this disease is such, 
oftentimes, in the beginning, that exercise does not in- 
crease action in the extreme parts, but produces an 
accumulation of circulating fluids in the internal viscera. 
The consequence of this often is, an increase of short- 
ness of breath, of pain, and of quickness of pulse. In all 
these cases, exercise should be prohibited as in other 
fevers. After the proper curative means have been used 
a suflicient length of time, moderate exercise may give 



PULMONARY CONSUMPTION. 

relief. It should afterwards bo steadily persisted in; 
for the affects of it last but a little while. In order, 
therefore, to receive permanent benefit, it should be al- 
most constantly employed, even to the point of fatigue. 

In cases of loug standing with but little fever, benefit 
has sometimes been gained by hard labour, connected 
with low diet. It is supposed, that these two last dimi- 
nish plenitude and arterial irritability, whilst exercise 
keeps up au equal circulation. It is therefore of much 
consequence, that exercise be well chosen, and rightly 
timed ; and without attention to these, it may do hurt. 
But when prudently used, it becomes a useful assistant 
in the cure of this obstinate disease. The warm or tem- 
perate season of the year should be chosen for out-door 
exercise ; and warm dress should be enjoined with flan- 
nel next the flesh. If the patient feels relief from exer- 
cise, it should be persisted in ; if he finds no relief, but 
inconvenience, it should be abandoned, and greater atten- 
tion paid to the principal curative remedies. Exercise 
is better adapted to finish and confirm a cure, than to 
begin it. 

h. Mucilages and demulcents. These arc of some use 
to allay the local irritation in the throat, and possibly in 
the lungs. The patient may use such as are most agree- 
able, or that he finds most useful. Gum Arabic, gum 
tragacanth, liquorice, sugar plums, slippery elm, flax- 
seed tea, spermaceti, and others may be tried. They do 
but little good towards a cure, but have their use in 
being comfortable assistants. 

If the patient should be troubled with a dry irritative 
cough, without expectoration, and attended with heat, he 
may receive relief by placing a mild steam in the bed, by 



*06 HEMARKS ON 

means of a tea-pot, or some other apparatus, so that a 
mild steam may be blended with the air he breathes. 
Emollient herbs may be infused in the liquor. Or take 
a new brick, and after moderately heating it, pour hot 
water upon it, and then cover it with a clean napkin, and 
lay it at an agreeable distance from his mouth, and in 
the bed ; this will be very comfortable and convenient, 
and may be often repeated. 

i. Sirups. Very much the same may be observed of 
these, as of the last articles. The above may be made 
into simple sirups, without spirit, except in the most 
exhausted and hopeless cases ; when a little spirit may 
be added to make them more agreeable and cordial. It 
is very much doubted, whether any article of the materia 
medica possesses any specific power in affecting the lungs. 
Many seem to have such an effect by promoting diapho- 
resis, or by an emetic, or some other general operation. 
Many also by stimulating the larynx, esophagus, and 
stomach, promote a secretion in the bronchial vessels. 
It is also very much doubted whether any permanent 
good effect is produced by much stimulation of these 
parts. Stimulating sirups should be avoided in every 
stage of the disease. In the after stages, mild mucila- 
ginous and moderately cordial sirups may be indulged; 
and from the comfort they give, the patient will often 
insist, that the sirup has been the means of his recovery. 

The tincture of balsam of tolu makes an agreeable 
and useful sirup. One drachm of the tincture to half a 
pint of warm water, sweetened with loaf sugar, to which 
may be added about ten drops of the essence of pepper- 
mint. Also may be tried sirup of onions, and of turnip. 
Elecampane, comfrey, spikenard^ colts foot, &e, may be 
used for these purposes. 



PU1M0XAKY COWIUMPTION. iU7 

Wliilst speaking of cordial sirups, it becomes proper 
to say something of anodynes and other cordials, as they 
will no where be admitted in the list of curative reme- 
dies. After some experience of anodynes or opiates in 
this disease, and observing their hurtful tendency, I was 
surprised to see them recommended by so many writers 
of celebrity. Their effect is to suspend irritation, but 
not remove it. They give only a deceitful respite to the 
disease ; and as in all other cases of suspended morbid 
action, it returns with force proportioned to the delay. 
The physician, willing to afford comfort and consolation 
to his patient, offers a medicine, that is taken with avidi- 
ty; and from the circumstance of the necessity of its 
repetition being increased, it is pertinaciously persisted 
in. Our views of this drug, in febrile action, have been 
anticipated ; it will only be observed in this place, that 
it is one of the most improper medicines that is usually 
exhibited in this disease. All the most salutary mea- 
sures will become of no avail, in severe cases, if this 
article is used. After all hopes of recovery have vanish- 
ed, it may be used in small quantities, especially to check 
diarrhoea. But who shall determine a case to be hope- 
less, when some have recovered from the most forlorn 
state ? 

The same, upon general principles, may be said of 
spirits, of wine, and other cordials. The hurtful effects 
of these will sooner be discovered, by attentive observa- 
tion, than the effect of anodyne cordials. The bad effect 
of opium is not commonly shown until a day or two after 
its exhibition, and when taken in small doses, perhaps 
later; and when the symptoms of fever arc aggravated 
by its nsc, it is commonly considered, that this is a neces- 



*t)8 REMARKS ON 

sary consequence of the disease, rather than the effect of 
the opiate. In this manner, both the patient and physi- 
cian are liable to be deceived, whilst the treacherous 
disease, and still more treacherous remedy, are securing 
the victory. 

k. Stimulating plasters. These relieve pain and pro- 
mote a determination to the surface. The burgundy 
pitch answers the purpose very well. Three or four 
may constantly be worn on some part of the thorax; one 
of them between the shoulders. They may occasionally 
be medicated with camphor and opium. A plaster on 
the hollow of each foot. 

1. Digitalis. This is a useful assistant, but by no 
means answers the recommendation it has had from high 
authority. It seems to possess a property of assisting, 
in translating diseased action from the lungs ; and diffus- 
ing it generally in the system ; and, if I am not much 
mistaken, of increasing a determination to the head. In 
small doses it is a safe auxiliary ; but a cure should 
never be entrusted to it. It is most useful in those cases 
attended with the least fever; or after the use of the 
more important remedies before mentioned. A saturated 
tincture may commonly be given in about forty or sixty 
drops tw r o or three times a day. My custom lately has 
been, to give the evening dose along with the nauseating 
or emetic dose, before mentioned. 

m. Salivation. In certain cases of long standing, and 
where the above remedies have been used sufficiently, 
and still the disease continues in a more moderate man- 
ner, this remedy may be used. It should not long be 
persisted in, and it should be used iu the most sparing 
manner, and accompanied with diaphoretics, for the 



PULMONARY CONSUMPTION. 409 

purpose of exciting universal action in the lymphatic sys- 
tem. The glands of the throat should he affected only 
in the slightest manner. If the before mentioned cura- 
tive means are properly applied, this remedy will be 
superseded, perhaps, in fourteen out of fifteen cases. If 
a suspicion should arise, that the disease may be con- 
nected with syphilis, from knowing the patient has been 
affected with it, the use of this remedy becomes more 
apparent. 

n. Seneca. An infusion of this, to which may be added 
loaf sugar, may be very beneficial to excite the lympha- 
tics. It will be most useful after some of the principal 
remedies have been used, and fever is abated. It may 
be taken about three times a day, as much as the stomach 
will bear without sickness. 

o. Elecampane, sulphur, and liquorice, being pulve- 
rized and made into an electuary, with honey or molas- 
ses, agreeable to Mr. Townsend's directions, are often 
very useful for the cough. It may be taken various times 
in the day. It not being our design to be very particu- 
lar, the minutiae of the curative part must be abandoned. 

If the art of healing could be communicated merely 
by describing a disease, and accompanying it with a 
set of recipes, the task of the practioner would be 
greatly diminished; the necessity of thought would be 
superseded, by a sort of mechanical impetus; and the 
abstruse science of physiology become a useless pursuit. 
Diseases would then be squared by the same rules, that 
the architect pursues in preparing and adapting the 
materials of an edifice. But the case is very differ- 
ent; every identical condition of disease has its own 
peculiarities, as correctly as every individual has his own 

52 



iiO REMARKS ON 

particular physiognomy. The rules of practice can only 
be general and common, or such as suil the predominat- 
ing character of the disease under consideration; but the 
quantity of remedies must depend wholly upon the par- 
ticular state of the individual case. On (his view of the 
subject, not only every new case presents a wide field for 
animadversion, but every visit demands a review and 
circumspection of the case, and perhaps some deviation 
in particular remedies. 

The art of medicinal practice not being an imitative 
art, sufficiently accounts for the failure of those, who in 
attempting to pursue the same line as others, are perhaps 
destitute of the landmarks and criterions, which alone 
can ensure success. Unfortunate attempts are often im- 
puted to those general schemes of practice, which under 
a discriminative and judicious application would have 
proved successful. 

"Whatever may be the fate of these propositions and 
remarks, the writer is satisfied they contain, in short 
terms, the true principles of the disease ; and that they 
lead to a successful method of cure, when well adapted, 
and discreetly applied. A considerable course of experi- 
ence warrants the assertion, that this disease, although 
obstinate in its character, should no longer be considered 
incurable in its nature. The tardiness of the disease 
gives ample opportunity for the use of remedies, and 
whilst in possession of so many, capable of producing 
astonishing changes in the economy of the system, we 
may fairly conclude, that nine tenths of the failures of 
cure, should be imputed to the obstinacy of patients, or 
the delinquincy of physicians. This is upon the supposi- 
tion, that common opportunity is offered. In the late 



PULMONARY CONSUMPTION. 411 

and adverse circumstances of cases, which are often met 
with, success can frequently bo ensured, by a firm and 
steady perseverance on the part of the physician. 

The truth of these remarks will be more apparent and 
better credited, when the generality of physicians shall 
have rid themselves of the asthenical foibles of the day, 
and become sufficiently apprized of the great necessity of 
suppressing morbid irritability, by an early subduction 
of internal stimuli ; and also when it shall be more ge- 
nerally understood, that the system is capable of sustain- 
ing life, without injury to its primitive economy, under 
astonishing evacuations and abstraction of stimuli ; and 
that disease diminishes in proportion to the reduction of 
morbid excitement. And furthermore, when it shall be 
more perfectly realized, that in proportion as morbid 
irritability is subdued, vitality is preserved from danger 
of exhaustion ; and that debility is oftener the effect than 
the cause of disease. 

When a physician is well established in the principles 
of treatment most proper to be pursued in this disease* 
he will often meet with much embarrassment from the 
fickleness of patients, and their unwillingness to submit 
to a severe regimen, when so many deceivers are pro- 
mising them a safe and speedy cure with some agreeable 
remedy ; either their own secret nostrums, or those puf- 
fed about in public advertisements, &c. containing, for 
the most part, some opiate preparation. They ought to 
be warned of the danger of their disease in plain terms $ 
and from their constant pi-oneness to skepticism, in this 
respect, they bear conversation on the subject better than 
in almost any other disease. They should frankly be 
warned of the danger of using temporizing remedies, and 
losing the most favourable period of relief. 



4d2 REMARKS ON 

Many doubts have rested on my mind, relative to the 
propriety of inserting cases of disease. It has at length 
prevailed, that it might be best to insert a few, merely 
to illustrate the principles advanced. 

Case i. In 1799, E. B. previously of a tolerable 
healthy habit, but of that sort called hectical, aged about 
twenty-four years, was attacked in June, with pain in 
the region of the thorax, cough, and a pulse about 120. 
The access was moderate, and all the symptoms warrant- 
ed the conclusion, that he was progressing into a con- 
sumption. I had not at that time the full confidence in 
the right method of cure, but was well established in the 
principle. In the course of a few weeks he was bled 
several times quite freely, and pursued an antiphlogistic 
course with blisters, setons, cupping, &c. I will here 
mention, that I have now but little confidence in setons 
nor local blood-letting, for it is a general disease, and 
requires general remedies. 

By this treatment, he gained apparently but little be- 
nefit, for about one month ; except in this circumstance, 
that the chief seat of pain seemed to move from the cen- 
tre of the thorax to the lower and back part of the dia- 
phragm, and about against the liver, occupying a space 
of about a hand's breadth on each side of the spine. 

The same treatment was continued, when in about a 
fortnight, the pain was chiefly confined to the region of 
the kidneys, or the psoas muscles, and gave serious ap- 
prehension of a lumbar abscess, as the fever continued 
quite severe. In about a fortnight more, it was found to 
remove lower down in a slow progressive manner, until 
it arrived within the boundary of the sacrum and os coc- 
cygis; giving the sensation of being situated between 
these bones and the rectum. At this time, a consulting 



PULMONARY CONSUMPTION. *lo 

physician concluded the case to bo ascarides, irritating 
the rectum. In compliance with his request, lime-wa- 
ter was injected, and some acrid materials, which added 
much to his distress. At the same time, opium and other 
stimulants were given. In the course of a few days his 
fever was increased, and attended with delirium for about 
two weeks, so severe, that it required two or four men 
to keep him on the bed ; and for several weeks, partial 
delirium. 

He was now treated with more bleeding and antiphlo- 
gistic remedies ; and after a few weeks an eruption 
began to appear in the anus, of a red fiery appearance, 
and spread gradually over the perinscum, and adjacent 
parts. The sensation this gave was almost intolerable. 
The skin became dry and cracked in all directions, and 
from the fissures issued an ichorous matter. The erup- 
tion continued its progress down the inside of the thighs 
to the lower end of the calf of the leg, healing behind as 
it made progress. It disappeared at this place after a 
continuance there of three weeks, when the fever and 
every symptom gradually vanished in about five months 
from the attack. I was knowing of his enjoying good 
health about ten years after, when he left the country. 

I considered this a very singular species of disease, 
and have mentioned it more to show the translation of 
local affection, than to show the quantity of anti-febrile 
remedies ; and also to make this remark, that it may be 
doubted whether the disease would have removed from 
the region of the lungs, if stimulants had been used at 
first. In confirmation of this, it may be noticed, that at 
the time it was within the region of the sacrum and coc- 
cygis, when stimulants were given, it tarried about 
twice the length of time it did at any other place. This 



414 REMARKS ON 

patient had no eruption before nor siuce that time, to niy 
knowledge. 

ii. In 1804, W. F. was progressively attacked with 
the common symptoms of phthisis. His cough became 
at length to be almost incessant without any expectora- 
tion, and attended with hoarseness, difficult respiration^ 
pain, quick pulse, &c. He had been some months in 
this situation, when he submitted to a strict regimen, 
with bleeding, emetics, &c. He was bled largely seven 
times in about two'months, when the disease gradually 
gave way, and he resumed his usual employment, with 
only slight phthisical symptoms occasionally, until the 
first of August, 1811. After indisposition for several 
weeks, and whilst attending moderately to business, he 
was affected with constant pain and soreness in his 
breast, particularly under the sternum, and at leugth 
with spitting of blood frequently every day. His pulse 
at this time was very small, quick, and oppressed. It 
proved to be a very obstinate case ; he had unequivocally 
in the course of his disease, all the appearances of a 
confirmed consumption. But by a diligent use of the 
aforementioned remedies, or a principal part of them, 
he has recovered his usual state of health, and attends 
to business. He passed the most critical period of 
his disease in about three months from the last date. 
He was bled largely fifteen times in this term of time, 
notwithstanding his emaciated appearance, and the 
smallness of pulse. His pulse, however, grew ful- 
ler after some of the first bleedings. He was bled three 
times in the course of two days in this term. After the 
above bleedings, he was bled three or four times in the 
course of the winter following. He enjoys very easy 
health at this time. January, 1815. 



PULMONARY CONSUMPTION. 415 

lie is of a spare habit , rather inclining to paleness ; 
and at the time blood was taken so profusely, his exter- 
nal appearance seemed to show, that he rather needed to 
have blood injected into his vessels, than any abstracted. 

in. Miss E. R. aged about twenty. I first saw her in 
May, 1S12. She had been affected with strong symp- 
toms of phthisis pulmonalis for about a year. Had spent 
the preceding summer in Massachusetts, in pursuit of 
her health. At this time her pulse was about one hun- 
dred and twenty in a minute, and spitting of blood at- 
tended her almost every day, with very constant pain in 
the region of the thorax. Also her cough had been upon 
her for about a year. In the space of three months, she 
had eight large bleedings, and a proportion of other 
remedies. By this time, she had passed the most criti- 
cal period of her disease, and became moderately con- 
valescent. In the course of about four months more, 
she was bled three or four times, when her health ap<= 
peared to be considerably established ,• and she has been 
entirely well to the present. She passed the most im- 
portant period of her disease about the last of August, 
when she had three very large bleedings within one 
week. As I do not often specify the quantity of blood 
taken at a time, it may be observed that I am not very 
solicitous about this ; but endeavour, when bleeding is 
necessary, to take sufficient to make some sensible 
change in the pulse. The three bleedings, just mention- 
ed, were about twenty-four ounces each ; rather larger 
than common. It may be worth noticing, that the fol- 
lowing winter, the epidemic pneumonia prevailed; it 
was in the neighbourhood and family she lived in, she 
was not affected herself, but enjoyed good health. 



416 REMARKS ON 

This case was considered a victory over gainsayers, 
who in ide such opposition, that I felt myself necessi- 
tated to take a greater share of responsibility, than ever 
ought to be laid upon a physician. 

iv. P. P. T. aged about six years; had, in former 
seasons been affected with fevers, but apparently of good 
habit. About the middle of January, 1814, was attack- 
ed with the symptoms of common fever. He was twice 
bled ; and, with the help of other remedies, became con- 
valescent. Again in the fore part ot* March, was attack- 
ed with fever and pain in his thorax with cough ; also, 
at the same time, with pain in his ear and throat with 
some swelling. As the mumps were in the neighbour- 
hood, it was considered he was affected. The affection 
of the throat subsided in a short time by one bleeding 
and the common treatment ; and for three weeks he 
appeared to have but little fever. It was soon discover- 
ed that his case was clearly becoming hectical ^attended 
with a dry cough. His pulse gradually became exceed- 
ingly quick, from one hundred and thirty to one hundred 
and sixty in a minute. By the 15th of April his sweats 
were very profuse, of that kind called colliquative; 
and his emaciation very great. His end was looked for 
from day to day. In this very low and emaciated state 
he was bled three times in about a week ; attended with 
blisters, milk diet and digitalis. Every bleeding, which 
was pretty copious, considering his condition, manifestly 
gave relief from the fever, sweats and distress; at the 
same time his expectoration was increased by them and 
now became pretty large. The last of the three bleed- 
ings apparently gave the most relief from sweats, fever, 
&c. He took nothing more stimulating than a week 
sirup of balsam tolu. 



TULMONARY CONSUMPTION. 417 

By the first of May, he was considered clearly conva- 
lescent, and by the middle of the same month, appeared 
almost free from disease ; but yet had not recovered his 
flesh and strength. The case ended in a few weeks 
more in perfect health. 

Perhaps this case might be considered as approximat- 
ing more to acute pneumonia, than more dilatory cases 
in adults. If so, the extreme state of exhaustion, with 
sweats, very small and quick pulse, &c. appeared equal- 
ly forbidding the use of what are called debilitating re- 
medies, as any condition whatever. At the same time, 
I never could feel so confident of success in the more 
protracted cases by this late treatment, as in the more 
recent ones. I am, however, in a condition to say, that 
I can produce eases in adults, who had laboured under 
the most manifest state of phthisis pulmonalis, for six 
and for twelve months, with great expectoration, and 
also emaciation, recovering by measures similar to the 
above. For this purpose will only be mentioned one liv- 
ing in this town, which will be put for the last, and, 

Fifth Case. G. F. aged about 22. He had been 
declining with the most marked symptoms of phthisis 
for about six months before I saw him. His expectora- 
tion was great. In the course of less than three months, 
he was bled largely three times. Notwithstanding his 
extreme exhaustion, he was every time benefited by 
them. These and collateral measures so far abated the 
violence of his disease, that he gradually recovered from 
a state, in which his death was looked for from day to 
day for about six weeks, to be able to attend some to 
business ; but is not yet free from a cough and expecto 

53 



415 REMARKS ON 

ration. This case was io ±80*. Every year has bet- 
tered his condition. 

It will only now be observed, that I have no recollec- 
tion of ever meeting a case, that any injury has been 
incurred, by the use of blood-letting, to my understand- 
ing. A few very late cases have gone wrong, with some 
blood-letting, and a partial use of the proper curative 
remedies ; and this must always be expected. 

I have no intention to say, that every case of this for- 
midable disease, can be cured even in the most favoura- 
ble state of trial. A belief, however, is entertained, all 
circumstances of application being equal, that this con- 
dition of disease is as much, and even more, under the 
control of remedies, as simple pleurisy. The applica- 
tion of remedies should perseveringly be persisted in, for 
the cure of phthisis, in proportion as the disease is more 
protracted, and obstinate. 

At the time I first began to turn my attention to medi- 
cine, a crimsoned cheek, a pulse a little quickened, with 
transient pain in the sight, with slight cough, were fre- 
quently considered fatal prognostics ; and I have heard 
some undertake, with much confidence, to fix the period 
of life, perhaps a year hence, even when the patient was 
but little indisposed, and was not enough alarmed to seek 
for assistance. It is to be hoped the age of prognosti- 
cating chivalry is passing by, and that physicians are 
becoming more ambitious to remove the hitherto sup- 
posed incurable diseases, than solicitous to secure their 
own doubtful fame by a fatal prediction. 

The unexpected recoveries in severe cases of acute 
and chronic diseases have been so numerous, it ought 
to teach us, that no one knoweth the period of existence, 



PULMONARY CONSUMPTION. 419 

save He who gave it. We ought also to be instructed, 
that some diseases, which are called incurable may not 
in reality be such, but stand as monuments of reproach 
to the negligence and ignorance of the Faculty. 

If the pursuits of physicians had been well directed, 
we have reason to think, that the disgraceful epithet of 
ars conjeeturalis, as applied to medicine, would have 
been hid in oblivion ages ago, in the land of our forefa- 
thers. If instead of seeking some peculiar plant, some 
spicy root, or some favoured flower, at the foot of some 
renowned mountain, possessing some specific power, the 
labour of physicians had been bestowed upon physiologi- 
cal fitness and nosological derangements, with observa- 
tions upon changes made by simple curative materials at 
hand; then, instead of the term of existence diminishing 
with passing years, the age of man, in obedience, might 
have approximated his pristine longevity. 

How far the labour of the writer has accomplished 
his wishes to effect usefulness by these sketches, must be 
left for others to judge; if they contain no merit, they 
will be equal to some that have gone before, and will be 
consigned to that land of forget fulness, where bodily 
infirmities teach he may soon follow. 



THE END. 



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